3rd Amendment 09/19/2018 �;�t couRre \11
Kevin Madok, CPA
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5,1(A,--TL ' *' Clerk of the Circuit Court & Comptroller — Monroe County, Florida
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DATE: September 21, 2018
TO: Maria Fernandez - Gonzalez
Employee Benefits
FROM: Pamela G. Hancoc i i1 .C.
SUBJECT: September 19 BOCC Meeting
Enclosed is a certified copy of Item C27, Amendment extending the Administrative
Services Agreement with Florida Blue in the amount of approximately $4.5 million for five (5)
years (beginning January 1, 2019 through December 31, 2023), with approximately $830,625.00 in
2019, to continue providing Claims Administration, Case Management and Utilization Review
Services, Disease Management, Network Management, Wellness Programs and other Related
Services to Monroe County, for your handling.
Should you have any questions, please feel free to contact me at ext. 3550. Thank you.
cc: County Attorney
Finance
File
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KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 Plantation Key, Florida 33070
305 - 294 -4641 305 - 289 -6027 305- 852 -7145 305 -852 -7145
AMENDMENT TO ADMINISTRATIVE SERVICES AGREEMENT
THIS AMENDMENT, entered into on September 6 , 2018 is by and between
Blue Cross and Blue Shield of Florida, Inc. d /b /a Florida Blue (hereinafter called "Florida
Blue ") and Monroe County Board of County Commissioners (hereinafter called the
"Employer "). In consideration of the mutual and reciprocal promises herein contained, the
Administrative Services Agreement between Florida Blue and the Employer (hereinafter
"Agreement ") effective November 1, 2011, as amended on October 21, 2015 and further
amended on December 14, 2016, is amended as follows:
1. Section I, subsection 1.1, is hereby amended to extend the term of the Agreement
until December 31, 2023 unless the Agreement is terminated earlier in accordance
with the terms of the Agreement.
2. Exhibit B, Financial Arrangements, to the Agreement is hereby amended, effective
January 1, 2019. The revised Exhibit B is attached to this Amendment and replaces
the Exhibit B previously attached to the Agreement.
3. Exhibit F, Discount Guarantees, to the Agreement is hereby amended, effective
January 1, 2019. The revised Exhibit F is attached to this Amendment and replaces
the Exhibit F previously attached to the Agreement.
4. Exhibit G, Contract Clauses Required By Federal Or State Statute, is hereby
attached and made part of the Agreement.
5. Except as otherwise specifically noted in this Amendment, all other terms and
conditions of the Agreement shall remain unchanged and in full force and effect.
IN WITNESS WHEREOF, this Amendment has been executed by the duly
authorized representatives of the parties.
BLUE CROSS AND BLUE SHIELD MONROE COUNTY BOARD OF
OF FLORIDA, INC. D /B /A FLORIDA COUNTY COMMISSIONERS
BLUE j
By: By: .. ' ' 0
Title: VP, Sales Operations Title: David Rice, Mayor • 3� p' 9/6/2018 Date: AlltivtlA&U //� Z° g
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, 4r .-. . KEVIN MADOK, Clerk N. cp
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EXHIBIT "B"
to the
ADMINISTRATIVE SERVICES AGREEMENT
between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D /B /A FLORIDA BLUE
and
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
FINANCIAL ARRANGEMENTS
I. Effective Date
The effective date of this Exhibit is January 1, 2019.
II. Weekly Payments.
A. Each week, Florida Blue will notify the Employer of the amount due to
satisfy the previous week's paid claims liability. The Employer agrees to
pay the full amount of the bill within thirty (30) business days of the written
notification consisting of a proper invoice and supporting documentation.
If the payment is not received by Florida Blue by the payment due date,
the payment will be considered past due. Florida Blue will immediately
suspend claims until payment is received by Florida Blue.
B. The Employer agrees to pay to Florida Blue, each month during and after
the term of this Agreement, an administrative fee, as set forth below. The
Employer agrees to pay to Florida Blue, each month, the administrative
fee within thirty (30) business days of the written notification consisting of
a proper invoice and supporting documentation of the amount due. If
payment is not received by Florida Blue by the due date, the payment will
be considered past due. Florida Blue will immediately suspend claims until
payment is received by Florida Blue.
III. Funding Information
A. Method of Funding Transfer: CHECK
IV. Administrative Fees:
A. Administrative fees during the term of the Agreement:
$48.25 per employee per month from January 1, 2019 through December
31, 2021. This fee includes 1.00 PEPM for Teladoc Services.
$49.75 per employee per month from January 1, 2022 through December
31, 2023. This fee includes 1.00 PEPM for Teladoc Services.
B1-
B. Florida Blue will pay the Employer a $50,000 wellness contribution in
2018, upon Board approval for the renewal and a $50,000 wellness
contribution on January 1, 2019 and January 1, 2020, January 1, 2021,
January 1, 2022 and January 1, 2023 provided the Agreement remains in
force and effect on the date on which payment is due. These funds may
be utilized by Employer at its sole discretion for any wellness related
initiatives or activities. If the Employer terminates the Agreement without
cause on or before January 1, 2024, Employer will pay Florida Blue an
early termination fee in the amount of $50,000 for each unexpired plan
year.
C. Administrative fees after the termination of the Agreement: 15% of claims
paid.
D. Access fees of up to 2.40% of Network Savings for PPO provider claims
and 4.30% of Network savings for Traditional provider claims may be
assessed for claims incurred in states under the BlueCard program as
explained in more detail under Section III, subsection 3.9 below. This
access fee will not exceed two thousand dollars ($2,000) for any one claim
and will not apply in Florida, South Carolina or in Consortium Plan service
areas where enrolled members reside as long as enrollment continues to
be equal to or greater than one thousand (1,000) contracts. On the first
anniversary date after enrollment falls below one thousand (1,000)
contracts, access fees will apply in those Consortium Plan service areas
where enrolled members reside and Consortium fees were not previously
established. Access fees will also apply in Consortium Plan service areas
where no enrolled members reside. A determination of the Consortium
Plan service areas that will not apply access fees for services rendered to
members will be made on the basis on enrollment on each subsequent
anniversary of this Agreement's effective date. Access fees will be applied
on the basis of where the service was incurred, and not where the
member resides.
Network Savings is defined as the total of the amounts computed by
subtracting each "allowed amount" for a particular service under the terms
of a participating provider's written agreement from each "billed amount"
for such service. In no event shall the term "Network Savings" include
duplicate charges or billed amounts for services or supplies not covered
under the Employer's Plan. The term "allowed amount ". means the
amount received as payment in full by a participating provider, under that
provider's written agreement, from both Florida Blue and covered
individuals under Employer's Plan for claims submitted to, and paid by
Florida Blue for a particular covered service, and the term "billed amount"
means the amount which would be received by such provider for the same
covered service utilizing that provider's charges.
V. Expected Enrollment
A. The administrative fees referenced above are based on an expected
enrollment of: 1,558.
B2-
B. If the actual enrollment is materially different from this expected
enrollment, Florida Blue reserves the right to adjust the administrative fees
as set forth in the Agreement. Administrative fees will be charged based
on actual enrollment. For purposes of this paragraph, the term "materially "'
means an increase or decrease of greater than ten percent (10 %).
B3-
EXHIBIT "F"
to the ADMINISTRATIVE SERVICES AGREEMENT
Between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D /B /A FLORIDA BLUE
And
MONROE COUNTY BOARD OF COUNTY COMMISSSIONERS
DISCOUNT GUARANTEES
Discount Guarantees are from January 1, 2019 through December 31, 2019.
Administrative Fee Discount Achieved Fee Credit Net
I Administrative Fee J
$48.25 62% or above $0.00 $48.25
$48.25 60% - 61.99% $1.00) $47.25
$48.25 58% - 59.99% $2.00 $46.25
$48.25 57.99% or below $3.00 $45.25
Assumptions:
• Applies to in- network provider claims only.
• BCBSF network and Program Savings Report will be used for validation of results.
• No significant benefit or contribution changes or membership changes by geographic
regions.
• Based on enrollment provided in the RFP.
• Blue products only, excluding RX.
• Inpatient hospital claims in excess of $150,000 will be removed in their entirety from the
discount guarantee calculation.
• Does not include COB.
• Does not include any ACO /PXMH surcharge.
• Does not include any ancillary products or AOR fees.
• Does not include nationwide BlueCard claims.
• Discount ranges are account specific and apply to total discounts only.
• Results will be provided on a quarterly basis with a final settlement no earlier than the
second quarter of the following year.
• One year offer.
EXHIBIT "G"
to the ADMINISTRATIVE SERVICES AGREEMENT
Between
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. D /B /A FLORIDA BLUE
And
MONROE COUNTY BOARD OF COUNTY COMMISSSIONERS
CONTRACT CLAUSES REQUIRED BY FEDERAL OR STATE STATUTE
Provisions Required by 2 CFR part 200.
1.1 EQUAL EMPLOYMENT OPPORTUNITY, NO DISCRIMINATION.
During the performance of this Agreement, the CONTRACTOR agrees as follows:
a) The contractor will not discriminate against any employee or applicant for employment because
of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor
will take affirmative action to ensure that applicants are employed, and that employees are
treated during employment, without regard to their race, color, religion, sex, sexual orientation,
gender identity, or national origin. Such action shall include, but not be limited to the following:
Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for training, including
apprenticeship. The contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the contracting officer setting forth the
provisions of this nondiscrimination clause.
b) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of
the contractor, state that all qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
c) The contractor will not discharge or in any other manner discriminate against any employee or
applicant for employment because such employee or applicant has inquired about, discussed, or
disclosed the compensation of the employee or applicant or another employee or applicant. This
provision shall not apply to instances in which an employee who has access to the compensation
information of other employees or applicants as a part of such employee's essential job functions
discloses the compensation of such other employees or applicants to individuals who do not
otherwise have access to such information, unless such disclosure is in response to a formal
complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including
an investigation conducted by the employer, or is consistent with the contractor's legal duty to
furnish information.
d) The contractor will send to each labor union or representative of workers with which it has a
collective bargaining agreement or other contract or understanding, a notice to be provided by
the agency contracting officer, advising the labor union or workers' representative of the
contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965,
and shall post copies of the notice in conspicuous places available to employees and applicants
for employment.
e) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965,
and of the rules, regulations, and relevant orders of the Secretary of Labor.
f) The contractor will furnish all information and reports required by Executive Order 11246 of
September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or
pursuant thereto, and will permit access to his books, records, and accounts by the contracting
agency and the Secretary of Labor for purposes of investigation to ascertain compliance with
such rules, regulations, and orders.
g) In the event of the contractor's non - compliance with the nondiscrimination clauses of this
contract or with any of such rules, regulations, or orders, this contract may be canceled,
terminated or suspended in whole or in part and the contractor may be declared ineligible for
further Government contracts in accordance with procedures authorized in Executive Order
11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked
as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of
the Secretary of Labor, or as otherwise provided by law.
1.2 OTHER FEDERAL CONTRACT REQUIREMENTS
The contractor and its subcontractors must follow the provisions as set forth in Appendix II to Part 200, as
amended, including but not limited to:
A. Debarment and Suspension (Executive Orders 12549 and 12689) —A contract award (see 2 CFR
180.220) must not be made to parties listed on the governmentwide exclusions in the System for Award
Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive
Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment
and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise
excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other
than Executive Order 12549.
B. Americans with Disabilities Act of 1990 (ADA) – The Contractor will comply with all the
requirements as imposed by the ADA, the regulations of the Federal government issued thereunder, and
the assurance by the Contractor pursuant thereto.
C. Disadvantaged Business Enterprise (DBE) Policy and Obligation - It is the policy of the County that
DBE's, as defined in 49 C.F.R. Part 26, as amended, shall have the opportunity to participate in the
performance of contracts financed in whole or in part with County funds under this Agreement. The DBE
requirements of applicable federal and state laws and regulations apply to this Agreement. The County
and its Contractor agree to ensure that DBE's have the opportunity to participate in the performance of
this Agreement. In this regard, all recipients and contractors shall take all necessary and reasonable steps
in accordance with applicable federal and state laws and regulations to ensure that the DBE's have the
opportunity to compete for and perform contracts. The County and the Contractor and subcontractors
shall not discriminate on the basis of race, color, national origin or sex in the award and performance of
contracts, entered pursuant to this Agreement.
D. Byrd Anti - Lobbying Amendment (31 U.S.C. 1352)— Contractors that apply or bid for an award
exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not
and has not used Federal appropriated funds to pay any person or organization for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, officer or employee
of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract,
grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -
Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are
forwarded from tier to tier up to the non - Federal award.
•
E. The Contractor shall utilize the U.S. Department of Homeland Security's E- Verify system to verify
the employment eligibility of all new employees hired by the Contractor during the term of the Contract
and shall expressly require any subcontractors performing work or providing services pursuant to the
Contract to likewise utilize the U.S. Department of Homeland Security's E- Verify system to verify the
employment eligibility of all new employees hired by the subcontractor during the Contract term.
F. The Contractor shall maintain a drug -free workplace in compliance with federal and state
(Florida) law.
G. Each party shall comply with the Federal Health Care Programs' Anti - Kickback Statute (42 U.S.C. §
1320a -7b) and any applicable regulations promulgated thereunder. The parties further recognize that this
Agreement shall be subject to the amendments of the Anti - Kickback Statute or any of its applicable
regulations. In the event any applicable provisions of the Anti - Kickback Statutes or its regulations
invalidate or are otherwise inconsistent with the terms of this Agreement or would cause one or both of
the parties to be in violation of the law, the parties shall exercise their best efforts to accommodate the
terms and intent of this Agreement to the greatest extent possible consistent with the requirements of
the Statute and its applicable regulations.
H. No Obligation by Federal Government. The federal government is not a party to this contract and is
not subject to any obligations or liabilities to the non - Federal entity, contractor, or any other party
pertaining to any matter resulting from the contract.
Program Fraud and False or Fraudulent Statements or Related Acts. The Contractor
acknowledges that 31 U.S.C. Chapter 38 (Administrative Remedies for False Claims and Statements)
applies to the Contractor's actions pertaining to this contract.
1.3 Florida Public Records Requirements:
Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the Contractor is required to:
(1) Keep and maintain public records that would be required by the County to perform the service.
(2) Upon receipt from the County's custodian of records, provide the County with a copy of the
requested records or allow the records to be inspected or copied within a reasonable time at a cost
that does not exceed the cost provided in this chapter or as otherwise provided by law.
(3) Ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law for the duration of the
contract term and following completion of the contract if the Contractor does not transfer the
records to the County.
(4) Upon completion of the contract, transfer, at no cost, to the County all public records in
possession of the Contractor or keep and maintain public records that would be required by the
County to perform the service. If the Contractor transfers all public records to the County upon
completion of the contract, the Contractor shall destroy any duplicate public records that are exempt
or confidential and exempt from public records disclosure requirements. If the Contractor keeps and
maintains public records upon completion of the contract, the Contractor shall meet all applicable
requirements for retaining public records. All records stored electronically must be provided to the
County, upon request from the County's custodian of records, in a format that is compatible with the
information technology systems of the County.
(5) A request to inspect or copy public records relating to a County contract must be made directly to
the County, but if the County does not possess the requested records, the County shall immediately
notify the Contractor of the request, and the Contractor must provide the records to the County or
allow the records to be inspected or copied within a reasonable time.
If the Contractor does not comply with the County's request for records, the County shall enforce the
public records contract provisions in accordance with the contract, notwithstanding the County's
option and right to unilaterally cancel this contract upon violation of this provision by the Contractor.
A Contractor who fails to provide the public records to the County or pursuant to a valid public
records request within a reasonable time may be subject to penalties under section119.10, Florida
Statutes.
The Contractor shall not transfer custody, release, alter, destroy or otherwise dispose of any public
records unless or otherwise provided in this provision or as otherwise provided by law.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY
TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT,
CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY AT
PHONE# 305 - 292 -3470 BRADLEY - BRIAN @MONROECOUNTY- FL.GOV,
MONROE COUNTY ATTORNEY'S OFFICE 1111 12TH Street, SUITE 408,
KEY WEST, FL 33040.