3.0 SCOPE OF SERVICES CMHA is seeking to enter into a contract with a qualified vendor as a Third Party Administrator (“TPA”) of the Authority’s self-insured Workers’ Compensation Program. CMHA is seeking to issue a three-year contract, with two one-year mutual renewable options. 3.1 REQUIRED SERVICES The following list is a description of the services required for the Third Party Administration of the Authority’s Workers’ Compensation Program: A. To provide services to CMHA as a self-insured employer, including, but not limited to: (a) first report of injury; (b) investigation; (c) compensability determination; (d) medical bill and indemnity payments; (e) settlements; and (f) hearing representation. B. To make a thorough study and survey of claims procedures to assure compliance with Ohio statutory and administrative requirements. C. To make a thorough inspection and audit of all claims and claim payments. D. To provide training, as necessary, to allow the program to function in accordance with the Ohio Bureau of Workers’ Compensation (“OBWC”) requirements. E. To provide consultation services on any and all matters in connection with claims, payments, and Ohio requirements and procedures. F. To provide consultation and supportive services on any and all accounting and statistical matters, including reporting requirements of an Ohio self-insured employer. G. To provide (a) monthly; (b) semi-annual; and (c) annual statistical summaries of all claims and cost data for CMHA’s use in evaluating the self-insurance program from both a fiscal and safety standpoint. H. To prepare, review, and file all reports and claims in compliance with the rules and regulations of the Industrial Commission of Ohio and the OBWC. I. To assist CMHA in the review and determination of all claims for compensability. Please note, all claims will be reviewed within twenty-four (24) hours of receipt to (a) determine compensability; (b) verify injuries and/or occupational diseases; (c) the extent of disability; and (d) the return to work date and/or status. While the TPA will collaborate with CMHA to assess compensability, the final certification will be solely determined by CMHA. J. To affiliate with competent legal counsel who is prepared to zealously defend on any pending issues and will attend any and all hearings before the Industrial Commission of Ohio arising from contested clams and any other matter. Note: If the cost of legal counsel is not included in the TPA’s annual fee, please include the cost of legal representation as a line-item in the Proposal response. K. To track attendance and provide reports by legal counsel for appearance at any and all hearings. L. To update, maintain, and provide 24/7 web-based access to CMHA of all records pertaining to Workers’ Compensation claims. M. Conduct quarterly review meetings with CMHA of all open claims and collaborate with affiliated legal counsel to collaborate on an approach to develop action plans for each pending claim. N. To provide indexing of all indemnity claims; re-indexing shall occur on a semi-annual basis. O. To provide clear, documented action plans for all claims to insure that the injured worker receives prompt, appropriate medical treatment while facilitating the employee’s return-towork date as soon as medically appropriate. P. To collaborate with CMHA to develop, implement, and maintain effective return-to-work practices. Q. To (a) review and adjust all approved compensable medical bills to usual, customary, and/or state mandated fee schedules and (b) upon receipt of all required medical documentation, pay those bills in accordance to OBWC requirements.
