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HomeMy WebLinkAboutC15-496 Labyrinth Healthcare GroupAOREEMENT FOR PROFESSIONAL SERVICES BETWEEN EAGLE COIJNTY, COLORADO AND LABYRINTH TH F{EAL"THCARE CROUP THIS AGREEMENT ("Agreement") is effective as of the I'r day of Jan uary,20l6by and betweenLabyrinth l"fealthCare croup a Delaware corporation (hereinafter'.Consultant,,or..Contractor,.) andEagle county, colorado. a body corporate and poritic (hereinafter.,countv,,). RECITALS wHEREAS. the County desires to contract with Consultant for certain medical advocacy and transparency services for its covered employees and legal dependents of those employees (..Menrbers,,); and wH8RH'AS' Consultant is authorized to do business in the state of Colorado and has the time, skill.expertise. and experience necessary to provide the Services as definecl belorv in paragraph I hereot and wHEREAS' this Agreernent shall goveln the relationship between clonsultant arrd county in connectionwith the Services. ACREEMENT Now' THERHFORH' in consideratiorr of the foregoing and the tbllowing promises consultant andCounty agree as follorvs: l' Services' Consultant agrees to diligently provide all services, labor. personnel ancl naterialsnecessary 1o perform and complete the services described in Hxhibit A ("Services.,) which is attached hereto and incorporated herein by reference, 'l-he Services shall be pert'ormeU in accordance with theprovisions and conditions of this Agreement. a' Consultanl agrees to furnish the Services on an ongoing basis in accordance with thestandards set forth in Exhibit A. lf no conrpletion date is specified in Exhibit A. then consultant agrees tofurnish the Services in a timely and expeditious manner consistent with the applicable slandard of care.By signing below consultant represents lhat it has the expenise and personnel necessary to properly andtimely perform lhe Services. b' In the event ofany conflict or inconsistency between the tenns and conditions set forth inExhibit A and the terms and conditions set fbnh in this Agreement, rhe terms and conditions set fbrth inthis Agreement shall prevail. c' Cottsultant agrees that it wilt nol enler into any consulring or other arrangements wilhthird parties that will conflici in any manner with the Services. Rrrvf '- ' Eagle County {{r.,,;,,iii;€15'OfflCf C15-496 2. Cou.nty's R.epresentatiye. The Eagle County Health and Human Services Depafiment's designee shall be Consultant's contacl rvith respec{ to this Agreement and performance of the Services. 3. Term.of the Aqreentent and Renewalf"erms. 1"his Agreemenl shall commence on January l, 2016, and subject to the provisions ofparagraph l2 hereof, shall continue in full force and effect through the 3 l " day of December. 201 6 (the "lnitial 1"erm"). This Agreement may be extended for up to three additional one year terms upon written agreemenl of the parties (each a "Renewal Term"). 4. Extension or Modification. This Agreement may nol be amended or supplemented, nor may any obligations hereltnder be waived, except by agreement signed by both parties. No additional services or work perfornred by Consultant shall be the basis for additional conrpensation unless and until Consultant has obtained written authorization and acknowledgement by County for such additional services in accordance with Counly's internal policies. Accordingly, no course of conducl or dealings between the parties, nor verbal change orders, express or implied acceptance ofalterations or additions to the Services, and no claim lhat County has been unjustly enriched by any additional services, whether or nol there is in fact any such unjust enrichnrent, shall be the basis ofany increase in the compeltsation payable hereunder. In the event thal wrilten authorizatioll and acknowledgment by County for such additional services is not timely executed and issued in slrict accordance with this Agreement, Clonsultant's rights with respect to such additional services shall be deemed waived and such fuilure shall result in non-payment for such additional services or work performed. 5. Compensation. For the Initial l'erm. County shall compensate Consultant for {he performance of the $ervices in a sum computed and payable as set fbrth in Exhibit A. For the Initial Term, rhe perfbrmance of the Services under this Agreement shall not exceed $19,000. The l"ees shall remain the same as set forth in Exhibil A for any Renewal Term unless Consultant notifies County of an adjustment to the fees at least one hundred twenty ( 120) days prior to the end of the lnitial Term or the then curent Renewal'[trm. This notification will be sent as noled in Section 10. Consultant shall not be entitled to bill at overtime and/or douhle time rates lbr work done outside of normal business hours unless specifically authorized in writing by County" a. Payment will be rnade fnr Services satisfactorily perforrned rvithin thirty (30) days of receipl of a proper and accurate invoice fronr Consultant. All invoices shall include detail regarding the hours spenl, tasks performed. who performed each task and such other detail as County may request. b. lf. at any time during the term or after termination or expiration ot'fhis Agreernent, County reasonably determines that any payment made by County lo Consultant was improper because the Services for which payment was made r,vere not performed as set forth in this Agreernent, then upon written notice of such determination and request for reimbursement from County. Consultant shall forthwith return such paymen(s) to County. Upon termination or expiration ol'this Agreement, unexpended funds advanced by County, if any. shall lbrthrvith be returned to County. c. Courrty will not withhold any taxes froni monies paid to the Consultant hereunder and Consullant agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the lerms of this Agreement. 2 Eagle County Prof Services Final 5,114 d' Notwithstanding anything to the contmry contained in this Agreementn County shall have no obligalions under this Agreement after, nor shall any payments be made to Consultant in respect of any period afier December 3 t of any year, without an appropriarion therefbr by County in accordance with a budget adopted by the Board of County Commissioners in cornpliance rvith Article 25" title 30 of the Colorado Revised Statutes, the Local Covernment Budget Law (C.R.S. 29-l -l0l et. seq.) and the TABOR Amendnrenl (Colorado Conslitution, Article X. Sec. 20). 6. $ub'consultants. Consultanl acknorvledges that County has entered into lhis Agreenrent in reliance upon the particular repulation and expertise of Consultant. Consultant shall not enter into any sub'consultant agreements for the performance of any of the Services or additional services without County's prior written consent, which may be withheld in county's sole discretion. Counly shall have the right in its reasonable discretion to approve all personnel assigned to the subject project during the performance of this Agreement and no personnel to whom County has an objection. in its reasonable discretion. shall be assigned to the Project. Consultant shall require each sub-consultanl, as approved by County and to the extent ofthe Services to be performed by the sub-consultant, to be bound to Consultant by the temrs of this Agreement, and to assume toward Consultant all the obligations and responsibilities wltich Consultant, by this Agreemenl, assumes toward County. County shall have the right (but not the obligation) to enfbrce the provisions of this Agreement against anv sub-consultant hired by Consultant and Consultant shall cooperate in such process. J'he Consultant shall be responsible for the acts and onrissions of its agents. employees and sub-corrsultants or sub-contractors. 7. Insurance' Consultant agrees to provide and maintain at Consuhant's sole cost and expense, the following insurance coverage with Iimits of liability nol less than those stated belorv: Types of Insurance. il. Workers' Compensation insurance as required by law. intentionally omirted. iii. Cornmercial Ceneral Liabitity coverage to include premises and operations. personal/advertising injury. products/completed operations, broad form property damage with limits of liability not less than $1,000,000 per occurrence and $2.000,000 aggregare limits. b. Other Requirements. i. The commercial general liability coyerage shall be endorsed to include Eagle County, its associated or afllliated entities. its successors and assigns, elecled officials, ernployees. agenrs and volunteers as additional insureds. ii Consultant's certificates ofinsurance shall include sub-consultants as addilional insureds under its policies or Consultant shall fumish to County separate certificates and endorsements fbr each sub-consultant. All coverage(s) for sub-consultants shall be subiect to llre same minimuni 3 irgle Counll'Prol' Services Final ,5114 requirements identified above. Consultant and sub-consultants, if any, shall maintain the foregging coverage in effect r"rntil tlre Services are completed. In addition, all such policies shall be kept in force by Consultant and its sub-consultants until the applicable statute of lirnitations for the project and the Services has expired. iii. lnsurance shall be placed with insurers duly licensed or authorized to do business in lhe state of colorado and with an "A.M. Best" rating of nor less than A-Vll. iv. Consultant's insuratrce coverage shall be primary and non-contributory with respect to all other available sources. Consultant's policy shall contain a waiver of subrogation against Eagle Counly. v. All policies must contain an endorsement affording an unqualified thirty (30) days notice ofcancellation to county in the evenl ofcancellation ofcoverase, vi' All insurers musl be licensed or approved to do business within the State of Colorado and all policies must be written on a per occurrence basis unless otherwise provided herein. vii. Consultant's certificate of insurance evidencing all required coverage(s) is altached hereto as Exhibit B. Upon request, Consultant shall provide a copy ofthe actual insurance policy and/or required endorsements required under this Agreement within five (5) business days of a written request from County, and hereby authorizes Consultant's hrokero without furlher notice or afihorization by Consultanl. to immediatel.v cornply with any written request of County for a complete copy of the policy. viii. Consultant shall advise Countv in the evenr the general aggregate or other aggregale limits are reduced below the required per occurrence linrit. Consultanl, at its own expense. will reinstate the aggregate linrits to comply r.vith the minimum lirnits and shall furnish Countv a new certi fi cate of insurance showi ng such coverage. ix' If Consultant fbils to secure and maintain the insurance required by this Agreement and provide satisfactory evidence thereof to County, Counly shall be entitled to imrnediately terminate this Asreement. X, termination hereof'. The insurance provisions of this Agreement shall survive expiration or xi' The parties hereto understand and agree that the County is relying on. and does not waive or intend to waive by any provision of this Agreement, the monetary limitations or rights, immunities and protections provided by the Colorado Covernmental Immunity Act, as frorn time to time amended, or otherwise available to County. its aft-iliated entities, successors or assigns, its elected officials. enrployees" agents and volunteers. Consultanl is not entitled lo workers' compensation benefits excepl as 4 flaglc Countl" Irrof Servrces l.inal Jll4 $ !, xlt provided by the Consultant' nor to unemploytnent insurance benefits unless unemployment compensation coverage is provided by Consultant or some other entity. The Consultant is obligated to pay a1 federal and state income rax on any moneys paid pursuant to this Agreement. 8' Indemnification. The Consultant shall indemnify and hold harmless County, and any of irs officers' agents and employees against any losses" claims. damages or liabilities fbr which County may become subject to insofar as any such losses, clainrs. damages or liabilities arise out ol directly or indirectly, this Agreement, or are based upon any perfonnance or nonperformance by Consultant or any of its sub-consultants hereunder; and Consultant shall reimburse County for reasonable attorney fees and costs, legal and other expenses incurred by County in connection with investigating or defending any such loss' claim, damage" liability or action. This indernnification shall not apply to claims by rhird parties against the County to the extent that County is liable to such third party for such claims withour regard to the involvement of the Consultant. This paragraph shall survive expiration or ternination hereof. 9' Confidentiality and Ownersllip of Documents. 'l'he Parties acknowledge and agree lhat some of the information utilized by consultanl ntay include confidential member health and personal identifying inforrnalion ("Confidential Member Information"). Parties shall not al any time during this Agreement or at any time therealler. use or permit others to use any of the Conficlential Mernber lnformation, except as may be necessary for the purposes of this Agreenrent. Consuhant agrees to comply with any applicable requirernents of the Flealth Insurance Portability and Accountability Act or other applicable laws and regulations in perforrnance of the Services. All documents prepared by Consultant in connection with the Services shall become property of the Member. 10" Notice. Any notice required by this Agreement shall be deemed properly delivered when (i) personally delivered. or (ii) when rnailed in the United States mail, first class postage prepaid, or (iii) when delivered by FedEx or other comparable courier service, charges prepaid. to the parlies at their respective addresses listed below. or (iv) rvhen sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date, tirne and receiving facsimile number for the fansmission. or (v) when transnritted via e-mail with confirmation of receipt. Either pafiy may change its address for purposes ofthis paragraph by giving five (5) days prior written notice ofsuch chanse to the other party. C-'OUNTY: Eagle County, Colorado Attention: Jacci McKenna 500 Broadrvay Post Office Box 850 Hagle. CO 8163 I Teleplrcne: 97 A 428-8796 Facsimile: 970-3?8-8799 [-Mai I : jacci.mckenna@eaglecounty.us With a copy ro: Eagle County Aftorney 5 [agle ('ount"r Proi' Seniccs f rnal j/14 r , 500 Broadway Post Ofllce Box 850 Eagle, Co 81631 Telephone: 970-328-8685 Facsimile: 970-328-8699 E-Mai|: atly@eaglecounty.us CONSULTAN'f: Labyrinth HealthCare Group Jane Cooper 633 W. Wisconsin Ave. #1310 Milwaukee, Wl53203 I l. Coordination. Consirltant acknowledges that the development and processing of the Services for the Project may require close coordination between various individuals and the County's health plan providers" Consultanf shall coordinate the Services required hereunder with the other consultants. contractors and individLrals thal are identified by County to Consultant fiom time to time, and Consulbnr shall imrnedialely notify such other consultants or conrractors, in writing of any changes or revisions to Consultanl's work product that might affbct the work of others providing services for the pmject and concurrently provide County with a copy of such notification. Consultanl shall not knowingly cause other consultants or contractors extra work without obtaining prior lvritten approval from County" lf such prior approval is not obtained, Consultanl shall be subject to any ofTset for rhe costs ofsuch exlra work. 12. Te,rnrination' County ntay terminate this Agreernent rvith cause upon 7 (seven) days wrilten nolice to Contractor. County may terminate this Agreernent, in whole or in part" al any time and for any reason, without cause. and without penalty therefor with ninety 90 calendar days' prior written notice to the Consultant' Upon terrnination of this Agreemenl, Consultant shall immediarely provide County with all documents as defined in paragraph t hereof, in such format as Counfy shall direct and shall return all County owned materials and docunrents. County shall pay Consultanr for Services satisfactorilv perfonned to the date of termination. 13. Di$nute Resolution. Venue. .lurisdiction and Applicable t.aw. The par"ties agree ro prgvide wriften notification to the other parly regarding any issues or concerns that arise during the Initial or Renewal terms. identifying the concern and providing rhirty (30) days to the other party ro rectify the problem' Any and all claims, disputes or controversies related to this Agreement that are not otherwise resolved, or breach thereof, shall be litigated in the District Court for ilagle County, Colorado" rvhich shall be the sole and exclusive forum fcrr such litigation. This Agreernent shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 14. [xecution by Counterparls: Electronic Signatures. T'his Agreemenl may he executed in two or more counterpafis, each of which shall be deemed an original" but all of which shall constitute one and the same instruntenl. The parties approve the use of electronic signatures for execution of rhis Agreement. only the following two fbrms of electronic signatures shalt be permitted to bind the parties ro this Agreement: (i) Electronic or facsimile delivery of a l'ully e.\ecuted copy of the signature page; (ii) the 6 Eagle County Prof Scrvrces Final Jil4 image of the signature of an authoriz..ecl signer inserted onto PDF format documents. All documenrs musr be properly notarized, if applicable. All use of electronic signatures shall be governed by the Unifonn Electronic Transactions Acr. C.R.S. 24-7 | .3-l0l to l2 l. t5. Other Contract Requirernents. a' Consultant shall be responsible for the completeness and accuracy ofrhe Services. including all supporting data or other documenls prepared or compifed in performance of the services, and shall correct, at ils sole expense. all significant errors and omissions therein. The fact lhat the County has accepted or approved the Services shall not relieve Consultant ofany ofits responsibilities. consultant shall perform tlre Services in a skillful, professional and competent manner and in accordancewith the standard of care. skill and diligence applicable ro consultants perforrning similar services. Consultant represents and rvarants that ir has the expertise and personnel necessary to properly perfonn the services and covenants that its professional personnel are duly licensed to perform the services withincolorado. This paragraph shail survive termination of this Agreement. b' Consultanl agrees to rvork in an expeditious manner. rvithin ihe sound exercise of itsjudgnient and professional standards, in the performance of rhis Agreement. Time is of the essence with respect to this Agreement. c' 'l'his Agreement constitutes an agreement lbr performance olthe Services by Consultant as an independent contractor and not as an employee of Counry. Nothing contained in this Agreernent shall be deenred to create a relationship of employer-employee, master-servant, partnership, joint venture or any other relationship between County and Consultant except that ofindependent contracior. Consultanr shall have no authority to bind Counry. d' Consultant represents and warrants that at all times in the performance of the Services. Consultant shall conrply with any and all applicable lau,s. codes, rules and regulations. e' This Agreernent contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding befween the parties r.vith respec{ thereto. f' Consultant shall nol assigtt any portion of this Agreement witlrout the prior written consent of the County. Any attempt to assign this Agreemenr without such consent shall be voicl. s' This Agreement shall be binding upon and shall inure to rhe benefir of rhe parties hereto and their respective permitted assigns and successors in interest. Enforcement of this Agreement and allrights and obligations hereunder are reserved solely for the parties. and not to any third party. h' No failure or delay by either party in the exercise of any right hereunder shall constitute arvaiver thereof, No waiver of any breach shall be iJeemed a rvaiver of any preceding or succeeding bre-ach. 7 Eagle Counry Pmf Seivices Frnal 5ll4 l"he invalidity, illegality or unenforceability of any provision of this Agreement shall not affect the validity or enforceability ofany other provision hereof. j' Consullant shall maintain for a minimum of three years, adequate financial and other records for reporting to County. Consultant shall be subject to financial audit by federal, state or county auditors or their designees. Consullant authorizes such audits and inspections of records during normal business hours. upon 48 ltours' notice to Consultant. Consultant shall fully cooperate during such audit or inspections. k. The signatories to this Agreement aver to their knorvledge, no employee of the County has any personal or beneficial interest whatsoever in lhe Services or Property described in this Agreement. lf"he Consultanl has no beneficial interest. direct or indirect, that would conflict in any manner or degree with the perfonnance ofthe Services and Consultant shall not employ any person having such known interests. l. The Consultant, ifa natural person eighteen (18) years ofage or older, hereby swears and affirms under penalty ol'perjury that he or she (i) is a citizen or otherwise lawfully presenf in the Unired States pursuant to federal larv, (ii) to the extenl applicable shall comply with C.R.S. 24-76.5-103 prior to the effeclive date of this Aqreement. 16. Prohibiti_ens qn Covernrnent Contracts. As used in this Section 16, the term undocumented individual will refer to those individuals from foreign countries not legally within the United States as set forlh in C.R.S. 8-l?.5-101. et. seq. tf Consultant has any employees or subcontractors, Consultant shallcornply with C.R.S.8-17.5-101, et. seq.. and this Agreement. By execution of this Agreement. Consultanl certilles that it does not knowingl;, employ or contract with an undoeumented individual who will perform under this Agreement and that Consultant rvill participate in the H-verify Program or other Deparlmenl of Labor ancl Employment program ("Department Program") in order to confirnr the etigibility of all employees who are newly hired for employment 1o perlorm Services under this Agreement. a. Consultanr shall not: i. Knowingly employ or contract rvith an undocumenred individual to perform Services under this Agreentent; or ii. Enter inlo a subcontracl that fails to certify to Consultant that the subcsntractor shall not knowingly employ or contract with an undocumented individual to perfonn rvork under the public contract fbr services. b. Consultant has confirmed the employrnent eligitrility of all ernployees who are newly hired lbr employment to perfornt Services under this Agpeement through participarion in the E-Veri$ Program or Department Program. as administered by the United States Department of Homeland Security. Information on applying lbr the E-verify program can be fbund atr 8 [agle County Prof Services final 5ll4 c' Consultant shall not use either the E-verify program or other Departmenl prograrn procedures to underlake pre-employment screening ofjob applicanrs while the public contract for services is being performed. d' If Consultant obtains actual knorvledge that a subcontractor performing rvork under thepublic contract for services knowingly employs or contracls with an undocumented individual, Consultanl shall be required to: i' Notify the subcontractor and County rvithin three (3) days thar Consultant has actual knowledge that the subcontractor i-s employing or contracring with an undocumented individual; and ii' T'enninale the subcontract rvith the subcontractor if within rhree days of receiving the notice required pursuant to subparagraph (i) of the paragraph (cl) the subconlractor does nor sropemploying or contracting with the undocumented individual; except that Consultanl shall not terminate the contract with the subcontractor ifduring such three (3) days the subcontractor provides information toestablish that the subconlractor has nol knowingly employed or contracted rvith an undocumented individual. e' Consultant shall conrply rvith any reasonable request by the Department of Labor and Hmployrnent made in the course of an investigation thar the department is undertaking pursuant to its authority established in C.R.S. 8-t 7.5-l 02(5). f' lf Consultant violates these prohibitions, County may terminate the Agreement for breachof contract' lf the Agreemenl is so tenninated specifically for breach of lhis provision of this Agreelnenl, Consultant shall be liable for actual and consequential damages to County as required by law. g' County will notify the Colorado Secretaly of State if Consulrant violates rhis provision of this Agreemenl and count.v terminates the Agreenrent for such breach. li REMAINDER OF PA6E INI'ENTIONALLl' LEFT'BLANK I/ 9 ijagle County Prof Serr.rces Final 5ll4 i & IN WITNESS WHORHOF, the parties have executed this Agreement the day and year tirst set forth above. CONSUTT B.v: Print Title: COUNTY OT EAGLE, STATE OF COLORADO, By and Through hs COUNTY MANACEIT 10 $agle County Pnrf Seniccs Final 5/14 By: rent McPall. EXHIBIT A SCOPE Ot. SERVICES, SCHEDULE. FEES 11 [agle Count],Prof Services !'inal 5ll,l EXHIBIT'B Insurance Certificate fagle County Prol Senices Final 5/14 EXHIBIT A STATEMENT OF WORK For purposes of this Statement of Work, Eagle County shall be refered to as ,,Client', and Labyrinth Healthcare Group shall be referred to is "LHG." 1. LHGResponsibilities a' LHG agrees to provide advocacy services more fully set forth on Exhibit A-1 to allClient's employees and legaldependents who are insured under Client'shealth insurance plan ('Members"). LHG does not provide clinical or legaladvice. Assistance by LHG with claims issues does not guarantee claimpayment. b' LHG will assist Members with issues associated with the Client's plans during the effective dates of membership. Assistance will be provided io Membersfor issues incurred up to twenty-four (24) months prior to the date of the Member's call. LHG will not assist Member with issues subsequent to the lastday of Member's month of termination from Client or subsequent to theTermination Date of the Agreement. c. LHG agrees to provide standard reports to Client on a semi-annualbasis. Standard reports include:i. Resolved service requests for most recent period by resolution typeii- Resolved service requests for rolling 12 month perioC by resolution typeiii. Cost savings report The fee for standard reports is inctuded in the fees as ouilined in Section3. There is an additionar charge for special request reports. d. LHG agrees to accept service requests directly from Members and as transferred calls from client's human resources department. 2. Client Responsibilities a. Client agrees to distribute initial Palient Care enrollment information to all Members and to distribute subsequent program information to encourage utilization of services. Members will be required to comptete a HIpAA release fiorm that allows LHG to obtain medicaland claims information. b. Client agrees to provide an initial electronic eligibility file to LHG on or before the effective date and a fult replacement and complete electronic nnonthly eligibility file in an agreed upon format in a timely manner. All J electronic eligibility files will include a match between benefit elections and members. c. Client agrees to provide information and to provide a copy of all company sponsored certificates of coverage and other related material prior to implementation and upon renewal of insurance coverage. Failure to do so could result in higher fees or termination by LHG" d. Clienl agrees to refer Members io Patient Care for assistance with health care and insurance issues. 3. Pricinq a. For the lnitiaf Term, Client will pay LHG the monthly fee of $3.7b per covered employee. This fee covers the empfoyees and their legal dependents (Members). Fees will be billed to Client or their designee on a monthly basis. This fee shall remain the same for each RenewalTerm unless notice is provided in accordance with Section 5 of the Agreement. b. Client will pay a one-time set up fee of $550.00 prior to the effective date to cover the cost of implementation expenses. c. Employee materials are included in the per employee per month fees and set up fees in the InitialTerm (as defined in the Agreement). ln Renewal Terms (as defined in Section 4), shipping fees for employee materials that exceed $50"00 wilf be billed to Client at cost. 4. Patignt Care $ervices During the Term of the Agreement, Labyrinth HealthCare Group ("LHG") will perform the following Core Services (collectively referred to as "Patient Care")for the Members: a. Advocacy Services With Patient Care, Members have access to advocates. These advocates willassist with medical, dental and vision, FSA, HSA and HRA issues as follows: Working to resolve any health plan billing, balance billing and authorization problems by calling the insurance company, the hospital and the doctor to resolve the problem. Finding the right type of health provider when the Members need care Navigating with Members through the complex maze of the health care system. Verifying that answers received from the health plan are accurate and reasonable. 1. 2. 3. 4. 5. Education on and assistance with the appeals and grievance6 fffffi,:!1ffi,'1x::i:kfi[,ffiil:,iJl"r:.,ij,,n", Members can understand 7 ' Helping Members prepare for hospital care so that they have all of the information they need and understand the decisions that they are facing,8. Understanding and using the most cost effective prescription drug options; and9. Understanding and using health savings accounts and health reimbursement arrangements effectively if available to Members. LHG and Patient Care intervention does not guarantee claims payment. LHG is not afiduciary for the Client's benefit plan. b. Transparency Services Cost and Quality comparison data is provided for medicat services only. Members mustcontact Patient Care a minimum of 7 days prior to the date of the r"wi.". prior to anyelective admission, surgery or procedure, patient care advocates will provideassistance to Members as follows. 1, Members may request a transparency report, which, unless a laterdeadline is mutually agreed upon between the advocate and Member,will be provided no later than 10 business days from the date Memberinitiates a requ.e.st for Transparency seryiies, The Transparency Report will provide information to the meniber on the total and out ofpocket costs for 2-3 network providers as well as available quality dati.2. when possible, advocates will schedufe appointments for Membersbased on the Member's chosen provider. 3. Advocates will coordinate with home healthcare agencies, skillednursing facilities, rehab, etc. to ensure smooth transition of care andpossibly reduce length of stay.4. Advocates will assist with any prescription drug issues or questions related to the procedure or admission. c. Exchange Advocate Advocates wifl assist Members with Medicare plan as follows: choosing and using their Exchange, Medicaid or 1 comparing and understanding all choices available to a Member2. Clarification about subsidies and qualification rules3 Explanation of benefits under each plan I Help finding a primary care physician in network5. Assistance through the enrollment process "t' d. Rewards Program Advocates will educate Members of the Rewards Program and communicate the reward opportunity when presenting a transparency report. 1. Members will be rewarded when they cail patient Care for comparisons for all elective procedures * inpatient and outpatient2. Patient Care reviews the data with the Member.3. lf the Member chooses the lower cost provider they will get a reward of 20alo of the potentialsavings from Client, with no maximum cap -There is no fee assessed to Client for Eagle County's custom rewards program. 4. Savings willbe calculated by Patient Care using the difference between the lower employer cost and the highest employer cost (employer responsibility in the transparency report)5. The Member must confirm their choice of provider with Patient Care by submitting their EOB within 6 months of their original request in order to receive the incentive payment. Any exceptions to the 6 month rule must be approved by the county after review with cNlc. The only reason for extension would be if the processing of the claim took CNIC longer than 6 months due to complexig. e. Timing for Services 1. LHG representatives are available Monday through Friday from 6:00 am to 7:00 pm MST and Saturdays from 7:00 am to 1Z:OA pm M$T. 2. The callwillcome directly to one of LHG's Advocates, who will be assigned to work with the individual Member. Advocates will take information regarding the problem, reach agreernent with the Member regarding what wilf constitute "resolution" of the problem and agree on when they will talk again. The Member will be asked to complete a release of information form, which may be needed by the Advocate to get information from physicians, hospilals, the insurance company or, other providers. 3. All Members who use Patient care will have the opportunity to take a satisfaction survey measuring their satisfaction with LHG. CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: 1.0 7 6 5.7 2L6 REVISION NUMBER: 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 CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. an ADDITIONAL INSURED, the policy(ies) 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 M3, Milwaukee Branch P. O. Box 2227 kesha WI 53L87-2227 INSURED Labyrinth Healthcare croup 533 W Wisconsin Ave Ste13l-0 Mil-waukee WI 53203 Casualtv & S B:Travel-ers Casualtv & Suret lers Indemnitv of 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 CONTMCT 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. NSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF .MM/DDIYYYYI FOLICY EXP {MMTDD'YYYN LIMITS GEI | "or"=*a,o,- oaNERAL L.ABrLrry fl.*,".-rooe F loccunl_- Y Y 6AO4D5S4412 8/!3 /201s I /13 / 2016 EACH OCCURRENCE $1,000,000 UAMAGE IOTTENIhU PRFMISFS /F, 6ecrrrren.el $300, 000 MED EXP (Anv one oerson)$5,000 PERSONAL & ADV INJURY s1 ,000, 000 GENEMLAGGREGATE $2,000,000 GEI .I'L AGGREGATE LIMIT APPLIES PER:I f l pnn-IPOLICYI l'ii^-r I ILOC PRODUCTS . COMP/OP AGG $2,000,000 tmployee Benefits $1 , 000, 000 AU' - I o*"orro I nll owr.reo nuros I SCHEDULED AUTOS | ,.',,^ro orto. I I NON-OWNEDAUTOS BA4D5 73 00 I 8/n/20L5 /73 /2076 COMBINED SINGLE LIMIT (Ea accident)$1,0oo, ooo BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) q q c UMBRELLA LIAB EXCESS LIAB x I occuR-l "*,r.-u^o= cuP4Ds55967 t /1,3 /2015 I /L3 /2076 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DEDUCTIBLE RETENTION S5, OOO c WORKERS COMPENSATION AND EMPLOYERS'LtABrLrTY Y/N ANY PROPRIETOR/PARTNEFYEXECUTIVE T---I oFF|CEFVMEMBER EXCLUDED? | |(Mandatory in NH) lf yes, describe under DESCRIPTION OF OPERATIONS below N'A IDTBEI'B4D55555015 t/13/2075 8/13 /20!6 - twcstATU-t toTH. ^ lTnDvrrrrFcl lEo E.L. EACH ACCIDENT $s00, 000 E.L. DISEASE. EA EMPLOYEI $s00,000 E.L. DISEASE. POLICY LIMIT $s00,000 B Errors and Omissions Liab 106034020 t/L3/20L5 s/13/2016 Iach Claim 2,000,000\ggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Atiach ACORD 101, Additional Remarks Schedule, lf more space is requlred) Directors and Officers Liability: 91,000,000 for all claims. Fiduciaryclaims. Employrnent Practices: $250,000 Limit, $5,000 retention.Eagle County, its associated or affiliated entities, its successors and See Attached.. . Liability: $250,000 for a1l assigns, elected officials, CERTIFICATE HOLDER CANCELLATION Eagl-e County, Colorado Attn: PO Box 850 Eagle CO 81631 Jacci McKenna SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE $-wn aUrmn-t O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 2s (2009/09) AGENCY CUSTOMER ID: LOC #:#o*'OK ADDITIONAL REMARKS SGHEDULE Page r of r AGENCY M3, Mil-waukee Branch NAMED INSURED Labyrinth HealthCare Group 633 W Wisconsin Ave Stel-310 Milwaukee WI 53203POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ronMNuMaen: 2!__ FORMTTTLE: CERTIFICATE Ow :mployees, agents and volunteers are li-sted as an additional insured in respect to vhere-required by written contract. Primary and Noncontibutory status and a waiver vhen required by written contract. ceneral Liabilityof subrogation apply @ 2006 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 101 (2008/01)