HomeMy WebLinkAbout25Q - PROCESSING WC AND LIABILITY CLAIMSREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE:
SEPTEMBER 8, 2009
TITLE:
VALLEY OAK SYSTEMS AGREEMENT
AMENDMENT
CITY MANAGER
RECOMMENDED ACTION
CLERK OF COUNCIL USE ONLY:
APPROVED
^ As Recommended
^ As Amended
^ Ordinance on 15f Reading
^ Ordinance on 2"d Reading
^ Implementing Resolution
^ Set Public Hearing For_
CONTINUED TO
FILE NUMBER
Approve and authorize the City Manager and the Clerk of the Council to
execute the First Amendment to the Valley Oak Systems Agreement in an
amount not to exceed $60,000 during the first year. The term may be
extended for up to five additional one-year periods in an amount not to
exceed $45,000 annually.
DISCUSSION
The City has utilized the services of Valley Oak Systems (VOS) since
March 16, 1999 for the processing of workers' compensation and liability
claims.
The first amendment to the Valley Oak Systems Software License, Service,
and Maintenance Agreement reaffirms the amount of the annual maintenance
fees. The amendment also includes the provision of a new module designed
to assist the City in complying with Medicare and Medicaid reporting
requirements.
25Q-1
Valley Oak Systems Agreement Amendment
September 8, 2009
Page 2
FISCAL IMPACT
Budgeted funds are available in the FY 2009-2010 Workers' Compensation
Contractual Services Account (account no. 82-178-6291) and the Liability
and Property Insurance Contractual Services Account (account no. 80-180-
6291) .
APPROVED AS TO FUNDS AND ACCOUNTS:
a
Kathie Gonzalez
Executive Director
Personnel Services Agency
Francisco Gutierrez
Executive Director
Finance & Management Services Agency
25Q-2
FIRST AMENDMENT TO VALLEY OAK SYSTEMS
SOFTWARE LICENSE, MAINTENANCE AND SUPPORT AGREEMENT
THIS FIRST AMENDMENT, made and entered into this 8~' day of August, 2009, by and between,
VALLEY OAK SYSTEMS, INC., ("VOS") and the City of Santa Ana, a charter city and municipal
corporation duly organized and existing under the Constitution and laws of the State of California
("City"), collectively referred to herein as "the Parties".
RECITALS
A. The Parties entered into that certain agreement entitled "SOFTWARE MAINTENANCE
AND SUPPORT AGREEMENT", dated February 20, 2007, (hereinafter "said Agreement"),
for maintenance and support services for the VOS workers' compensation and liability claims
software utilized by the City's Personnel Agency, Risk Management Division.
B. The Parties now desire to amend said Agreement to provide continuous service under the
terms of said Agreement and to include the provision of a new module designed to assist the
City in complying with Medicare and Medicaid reporting requirements.
WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter
contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended,
the parties hereto do hereby agree as follows:
1. Section 1, MAINTENANCE AND SUPPORT SERVICE, shall be amended to add subsection
"e", which shall read:
"VOS shall provide its CMS Module which allows the City to comply with Medicare and
Medicaid reporting requirements, as set forth in Exhibit A-l, attached hereto and incorporated by
this reference."
2. Section 3.a, TERM AND TERMINATION, shall be amended to extend the term for an
additional one-year period, through September 30, 2010. The term may be extended for up to
five additional one-year periods, at the option of the City.
3. Section 4, FEES AND CHARGES, shall be deleted in its entirety and replaced with the
following:
"a. The fee for the maintenance and support services provided for herein shall not exceed
$29,932.93, during the first one year extension of said Agreement. It is hereby agreed that
the renewal rate for this Maintenance Agreement shall either be the same as the current
year's rate or at an increase not to exceed the Consumer Price Index (CPI) Los Angeles -
Riverside -Orange County area.
b. City agrees to pay and VOS agrees to accept, as full payment for the purchase of the
CMS Module, aone-time fee of $15,000. Annual maintenance and support for the CMS
Module shall not exceed $5,625.00 during the 2009-10 Agreement term. It is hereby agreed
25Q-3
that the renewal rate for maintenance of the CMS module shall either be the same as the
current year's rate or at an increase not to exceed the Consumer Price Index (CPI) Los
Angeles- Riverside -Orange County area.
c. Consulting services, including consulting, custom setup and configuration and
installation of new upgrades or updates, shall be billed on a time and materials basis at an
hourly rate as set forth in Exhibit B-1, attached hereto and incorporated by this reference.
d. Total fees and charges for all services provided pursuant to this Agreement shall not
exceed $60,000.00, during the first one-year extension of said Agreement. If the City
exercises its option to renew, total fees and charges during the additional one-year extensions
shall not exceed $45,000.00, as set forth in Exhibit B-1."
4. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and
in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date
and year first above written.
ATTEST:
CITY OF SANTA ANA
MARIA D. HUIZAR
Clerk of the Council
DAVID N. REAM
City Manager
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By:
Laura Sheedy
Assistant City Attorney
VALLEY OAK SYSTEMS, INC.
(NAME)
(Title)
25Q-4
eNews
+eSOi_Ul'IONS
August 6, 2009
Medicare & Medicaid Services Mandatory Insurer Reporting Project Update
**IMPORTANT: TO ENSURE THIS INFORMATION !S PROVIDED TO APPROPRIATE PARTIES, PLEASE FORWARD THIS
TO PERSONNE! WITHIN YOUR ORGANIZATION WHO ARE HANDLING CMS REPORTING**
Please address all questions to su ort valle oak.com or by calling 925-242-4672.
This the fourth of several eNews communications that will be distribu#ed to provide on-going, detailed information
related to the CMS project and related updates. This communication is designed to address numerous questions that
have been presented. ff there are additional questions that are not addressed below, please contact Aon eSolutions
SUppOrt and inGude "CMS reporting question" in the subject line of the email.
PLEASE NOTE: Aon eSolutions hosted a Webinar session on May 20,2009. For clients who were unable to attend
on May 20, the session was repealed on June 17, 2009. The following topics were reviewed:
^ How iVOS will assist clients in meeting the CMS reporting requirements.
^ What clients will need to do in preparation to utilize the iVOS solution.
^ What we have done to prepare the iVOS product.
^ Timeframes and goals
^ Q&A
The May 20, 2009 .Session Recording can be found in the following location:
httpSaloon-[3cnli rtin.,~ ,..eti,.,. ,._~ ~--- - - ..
1~ //aon1esn,ld09 Seus~io~n Recording can be found in the following location:
CMS Reporting Overview
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173), adds new
mandatory reporting requirements for group health plan (GHP} arrangements and for liability insurance (including seff-
insurance}, no-fault insurance, and workers' campensa#ion.
For those of you not familiar with this topic, the Centers for Medicare and Medicaid Services (CMS) overview
documentation is accessible at the fallowing location:
htta://www.cros hhs eov/mandatorvinsrea/
Since this affects so many of our clients, Aon eSolutions has taken the approach of providing an iVOS solution that
will assist our clients in obtaining applicable claim data to meet reporting requirements.
Exhibit A-1
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25Q-5
Project Status and Important information
Aon eSolutions continues to work on our solution to support all currently published CMS reporting requirements. We
are attending Town Hall Teleconferences and have obtained the Latest version of the reporting requirements and the
alert document provided on the CMS website, including the changes that were made this week by the CMS.
As July is here, many of you are most likely registered with CMS and will be ready to begin testing in the immediate
future. Please note, if you have not already done so, please ensure that you contact CMS and request the HEW
(HIPAA Eligibility Wrapper) software and install the application at your si#e. The Aon eSolutions functionality does not
currently include the 270/271 translation software. When the Eligibility query is run the resulting fla# file will need to be
processed through the HEW software and the resulting file format is what will be provided to COBC for processing.
The resulting response file from COBC will need to be processed through the HEW software and the resulting
unencrypted flat file is what will be imported in#o the iVOS system to update claimant eligibility information.
Aon will be providing CMS functionality in two or more releases. iVOS users {using 4.1.6.x, 4.1.7.x, 4.2.2.x, 4.2.3.x)
will be able to download the functianality and install in a test region or on their laptop to begin working with the
functionality when it becomes available. Estimated availability dates are:
• 4.2.3.4 -August 10, 2009.
4.2.2.1 -August 21, 2009.
^ 4.1.7.2 -August 10, 2009.
• 4.1.6.3 -August 17, 2009.
This initial release will include the following:
1. New Medicare tab and associated database changes.
2. Screens to enter RRE and RRE ID information and tc define how claimants will be linked to the RREs.
3. Scheduled Jobs functionality to:
^ Assign RRE IDs to claimants.
^ Run the Eligibility query and generate a flat file of names, SSN, DOB, Gender #o be searched.
^ • Process the CMS/COBC Eligibility Query Response File and update claim/claimant information with
eligibility status
4. Eligibility Data Gap report that will fist claimants who do not include all five data elements to be included in the
search. Aan functionality will not include a claimant on the query until all flue data elements are provided.
5. Business Rules for:
• Notifying users when a claimant has been identified as a Medicare beneficiary in the eligibility
response from CMS.
if you attended one of the recent webinars you may recall clients asking about information related to the pricing of the
Aon eSolutions iVOS CMS functionality. The response was that we didn't have the pricing information available at
that time. In addition, the 614 webinar recap email noted the fallowing question '1Nhat is the cost for this solution?"and
at that time, the answer was "Fees have not been determined at this time". Product Management has announced that
the cost for the optional CMS module is $25,000 {+ $5,825 annual maintenance), however, if a Statement of Work
(SOW) is signed by 9/30/20Q9 the fee is discounted to $15,000 {annual maintenance fee remains at $5,625). For
more information and/or to purchase the CMS module please contact your Client Development Manager.
As an attachment to this communication, we're providing a preview of the Detailed User Guide and Configuration
Instructions documentation which will be provided with the functionality release. The Support Team will be able to
assist as needed to answer any iVOS related questions.
Webinars to provide an overview of how to use the tVOS functionality will be scheduled in the near future. More
details will be provided in a future eNews communication.
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25Q-6
At the CMS Technical Town Hall mee#ings last week, CMS reviewed several anticipated updates/revisions to the CMS
User Guide as well as changes in the file formats and data element requirements. Aon wil! respond to the changes as
soon as possible, but await the posting of the revised documentation to complete the analysis and design edits. CMS
posted the revised documentation on July3lst, which we are reviewing and making required changes to support the
requirements.
Aon eSolutions will provide a second release of functionality in early -mid Q4, 2009. This release will include
functionality related to the quarterly Claim Reporting process and will include the ability to generate an export file,
process CMS response files, business rules and historical reporting quick view report. More details will be provided in
the near future.
Current CMS User Guide documentation provided as of 03/16/2009 can be found at the following location. !t is
strongly advised that you read pages 1-80 to get all informs#ion related to CMS reporting.
htto://www cros.hhs.eov/MandatorvlnsRen/Downloads/NGHPUserGu~de031609 ndf
The CMS alert posted 05/11/2009 can be found a# the following location:
htto://www cros hhs oov/MandatorvlnsRen/Downloads/NGHPV10UserGuide051109 pdf
The CMS alert posted 04/07/2009 can be found at the following location:
htt ://www.cros.hhs. ov/Mandator InsRe /Downloads/NGHPAIertTPOC. df
The CMS alert posted 43/20/2009 can be found at the following location:
htt~:l/www.cros.hhs.eov/MandatorvlnsRen/DownloadslAllert UserGu~deSunn NGHP gdf
The CMS implementation timeline is published in the following location:
httns://www.cros.hhs aov/MandatorvlnsRen/Downloads/MMSEATIMELINE ndf.
• Section 111 re ortin re uirement testin
p g q g period begins 7/1/2009 and per the CMS alert published on 3/20/09, the
testing period was extended through 3/31/2410 (see
httn://www cros.hhs.eov/MandatorvlnsRen/Downloads/NGHPV10UserGuide051109 ndf}. Aon eSolutions anticipates
del~venng 4.1.x and 4.2.x service packs to support this testing timeframe.
• Prior to the testing period, all Responsible Reporting Entities (RREs) are required to register with CMS between
5/1/2009 and 9/30/2409. Information related to the registration process can be found on the CMS website at:
httas://www.cros.hhs.aov/MandatorvlnsRen/Downloads/ResistratianOverview ndf
The registration process will not include requirements for any fife exports or imports.
• Aon eSolutions focus is on the NGHP (Non Group Health Plan} requirements; Group health requirements will not be
addressed.
Note: Please contact support if you feel that you have to report under Group health requirements.
• IMPORTANT: Aon eSolutions is not acting as an "agent" on behalf of our clients. Func#ionality will provide the ability
to generate a data export containing applicable data in a format designed for reporting to COBC. However, the file
submission rocess will be the res onsibilit of clients that are RRE or a ent actin on behalf of RRE.
Note: [f you choose to self report, you can make use of existing functionality within ibOS to schedule the running
and transmission of this extract.
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25Q-7
~eSOLUTIONS
February 13, 2009
Carolyn Richard
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Renewal Infiormation for The City of Santa Ana
RE: iVOS~ Renewal and CMS Module Purchase
Dear Carolyn:
This letter is to provide documentation for The City of Santa Ana's iVOS Renewal
and purchase of the CMS Module. An addendum for the CMS Module will be sent to
you separately; it can be attached to the Amendment as an appendix. Per our
records, the iVOS Renewal and CMS Module purchase will be Amendment 4.
Fee Schedule
1• The anticipated cost per year (payable by XX date) for annual IVOS
maintenance fees to include annual CPI index increases not to exceed 5%.
Current Maintenance Amount: $28,507.55 (5% annual increase) payable 9/30
each year.
Year 1: $29,932.93 (10/01/09 - 9/30/10)
Year 2: $31,429.58 (10/01/10 - 9/30/11)
Year 3: $33,001.06 (10/01/11 - 9/30/12)
Year 4: $34,651.11 (10/01/12 - 9/30/13)
Year 5: $36,383.67 (10/01/13 - 9/30/14)
2. The anticipated cost per year (payable by XX date) for the annual CMS
module maintenance fees, again, if they are tied to an inflation index, so state, with
the amount anticipated each year, not to exceed 5%.
Module Cost - $15,000.00 -the contract must be signed and received prior to
9/30/09
Current Maintenance Amount: $5,625.00 (Year 1) (5% annual increase) payable
9/30 each year.
Year 1: $5,625.00 (10/01/09 - 9/30/10)
Year 2: $5,906.25 (10/01/10 - 9/30/11)
Year 3: $6,201.56 (10/O1/11 - 9/30/12)
Year 4: $6,511.64 (10/01/12 - 9/30/13)
Year 5: $6,837.22 (10/01/13 - 9/30/14)
Bishop Ranch 8 5000 Executive Parkway, Suite 340, San Ramon, CA 94583
Phone (925) 242-4600 Fax (925) 901-1020
Exhibit B-1
25Q-8
~eSOLUTIONS Renew
al Information for The City of Santa Ana
3. The hourly going rate, over the next 5 years, for the cost for consulting,
custom setup, installation of new upgrades or updates, billed on a time and
materials bases at an hourly rate not to exceed XXX for a maximum of 40 hours
during the course the contract.
Normal upgrades and updates are included in the Support and Maintenance fees
Implementation Services/Project Management time - $200.00/hour
Data Conversion - $150.00/hour
Custom Development - $250.00/hour
Training - $200.00/hour
Strategic Client Consulting -Dependent upon length of engagement
4. Total fees and charges for all services provided pursuant to this agreement
shall not exceed $60,000 annually.
The total estimated costs -not to exceed $60.000.00 annually are as follows:
CMS Module Purchase: $15,000.00
Total Annual Support and Maintenance
Year 1: $35,557.93 (10/01/09 - 9/30/10)
Year 2: $37,335.83 (10/01/10 - 9/30/11)
Year 3: $39,202.62 (10/01/11 - 9/30/12)
Year 4: $41,162.75 (10/01/12 - 9/30/13)
Year 5: $43,220.89 (10/01/13 - 9/30/14)
Feel free to call with any questions at (925) 242.6110.
Sincerely,
Kari Bryant
Client Development Manager
Bishop Ranch 8 5000 Executive Parkway, Suite 340, San Ramon, CA 94583
Phone (925) 242-4600 Fax (925) 901-1020
25Q-9
25Q-10