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On agenda:
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12/5/2023
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Final action:
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Title:
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Approve an Amendment to the Contract with UMR, Inc, for RFP No. 604028-16, for Medical and Dental Third-Party Administration (TPA) Services; and authorize the Chief Financial Officer or her designee to sign the Amendment; or take other action as appropriate. (Previous Amendments and original Contract are available for public viewing at the County Clerk's Office, Commission Division) (Also sitting as Clark County Water Reclamation District Board of Trustees, University Medical Center of Southern Nevada Board of Trustees and Mount Charleston Fire Protection District Board of Fire Commissioners) (For possible action)
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CLARK COUNTY BOARD OF COMMISSIONERS
AGENDA ITEM
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Petitioner: |
Jessica L. Colvin, Chief Financial Officer Les Lee Shell, Deputy County Manager Thomas A. Minwegen, General Manager Mason Van Houweling, Chief Executive Officer Jorge Gonzalez, Fire Chief |
Recommendation:
title
Approve an Amendment to the Contract with UMR, Inc, for RFP No. 604028-16, for Medical and Dental Third-Party Administration (TPA) Services; and authorize the Chief Financial Officer or her designee to sign the Amendment; or take other action as appropriate. (Previous Amendments and original Contract are available for public viewing at the County Clerk's Office, Commission Division) (Also sitting as Clark County Water Reclamation District Board of Trustees, University Medical Center of Southern Nevada Board of Trustees and Mount Charleston Fire Protection District Board of Fire Commissioners) (For possible action)
body
FISCAL IMPACT:
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Fund #: |
6520.000 |
Fund Name: |
Self-Funded Group Insurance |
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Fund Center: |
1020520000 |
Funded PGM/Grant: |
N/A |
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Amount: |
$5,219,616.48 annually |
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Description: |
Medical and Dental Third-Party Administration (TPA) Services |
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Additional Comments: |
The initial Contract amount was $1,751,742 annually. Amendment No. 1 increased the Contract amount by $941,184 annually, Amendment No. 2 increased the Contract amount by $24,000 annually, Amendment No. 3 increased the Contract amount by $303,578 annually, Amendment No. 4 increased the Contract amount by $275,000 for only the term ending December 31, 2020 and then $200,000 annually, Amendment No. 5 decreased the Contract amount by $145,394 annually and Amendment No. 6 increased the Contract amount by $1,597,938 annually, Amendment No. 7 will increase the Contract amount by $546,568.48 annually for a new annual Contract amount of $5,219,616.48. and a new total Contract amount of $39,255,045.94 should all renewal options be exercised. The Contract amount is subject to change as the Contract amount is based on a per member, per month cost of all eligible employees and retirees enrolled in the Clark County Self-Funded Group Medical and Dental Benefits Plan and Clark County EPO and is dependent upon the County exercising its option to implement optional services as identified within the Contract. |
BACKGROUND:
On August 2, 2016, the Board of County Commissioners (Board) approved the award of RFP No. 604028-16 to HealthSCOPE Benefits, Inc. (LBE) in the amount of $1,751,742 annually to provide Medical and Dental Third-Party Administration (TPA) services.
On August 4, 2021, the Department of Administrative Services, Purchasing and Contracts Division approved the Assignment of Contract from HealthSCOPE Benefits, Inc. to UMR, Inc.
The following are the pertinent provisions of the Contract:
• The term of the Contract was from date of award through December 31, 2017 and included the option to renew for 6, one-year periods. There are no renewal options remaining.
• Included the County’s option to terminate for cause, convenience or default and suspend the Contract with advanced written notice.
Amendment No. 1 provided for a Preferred Provider Organization (PPO) for medical and dental benefits for the Clark County Self-Funded Group Medical and Dental Benefits Plan.
Amendment No. 2 provided for the inclusion of claims administration services for offsite care of Clark County Detention Center inmates.
Amendment No. 3 replaced the Aetna PPO with the Sierra Health Options PPO and the Behavioral Healthcare Options PPO for the Clark County Self-Funded Group Medical and Dental Benefits Plan.
Amendment No. 4 increased the utilization of TPA services for the Clark County Detention Center and provided a discounted to align with the increase in volume.
Amendment No. 5 reduced the per member/per month premium rate for the Clark County Self-Funded Group Medical and Dental Benefits Plan from $7.87 to $6.87 for the term of January 1, 2021 through December 31, 2021.
Amendment No. 6 provided for the inclusion of the Clark County EPO Plan and allowed access to Centers of Excellence for organ transplants.
Approval of Amendment No. 7 will add 3, one-year renewal options and replace Exhibit 2, Medical and Dental Third-Party Administration (TPA) services Fee Schedule to include Subrogation (UMR) - Percent of Recoveries and Audit Credit - of $65,000 (2024 - 2025) and no increase for 2026. The attached Amendment No. 7 document details the modifications and costs involved.
UMR, Inc. currently holds a Clark County Business License.
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