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T-1997 MANAGED CARE WORKERS COMPENSATION SERVICES
STATE OF NEW JERSEY
DEPARTMENT OF TREASURY
DIVISION OF PURCHASE AND PROPERTY
PURCHASE BUREAU INDEX #: T-1997
NOTIFICATION OF AWARD - TERM CONTRACT(S)
CONTRACT TITLE: MANAGED CARE WORKERS COMPENSATION CONTRACT # 51467
SERVICES
CONTRACT PERIOD: APPLICABLE TO:
FROM: 07/01/02 TO: 12/31/09 ALL STATE AGENCIES
VENDOR NAME & ADDRESS: FOR PURCHASE BUREAU USE
HORIZON CASUALTY SERVICES INC Solicitation #: 33548
Bid Open Date : 01/31/02
33 WASHINGTON ST/11TH FL CID # : 1022238
Commodity Code: 958-61
NEWARK, NJ 07102 Set-Aside : NONE
CONDITIONS AND METHODS OF OPERATION
Multi-Source Contracts: State Agencies and Cooperative Purchasing partners
should review each vendor's product/service and prices carefully and
place orders in accordance with the terms and conditions of the contract.
Note that
A. Delivery: All prices F.O.B. Destination
B. Method of Operation - State Agencies Only: Issue an agency purchase order
to the appropriate contract vendor(s).
In the event of an emergency, contact the following in the order listed:
1.ROY HAMBRECHT - BUYER 3. MARGARET QUINN - BUYER UNIT SUPERV
609-292-3689
E-MAIL: ROY.HAMBRECHT@TREAS.STATE.NJ.US
2.KEVIN MOORE - BUYER SUPERVISOR 4. OFFICE OF THE BUREAU SUPERVISOR
609-292-1256 609-292-4751
PB177 (rev. 6/91) PUB. DATE: 11/06/09
INDEX NO: T1997
PAGE NO: 2
Notice of Award (NOA)
FOR
MANAGED CARE WORKERS COMPENSATION SERVICES
SPECIAL TERMS AND CONDITIONS
Table of Contents
1.0 Information for Bidders
1.1 Purpose and Intent
1.2 Background
2.0 Reserved
3.0 SCOPE OF WORK
4.0 Reserved
5.0 CONTRACTUAL TERMS AND CONDITIONS
5.1 Precedence of Contractual Terms and Conditions
5.2 Performance Bond
5.3 Business Registration
5.4 Contract Term and Extension Option
5.5 Contract Transition
5.6 Availability of Funds
5.7 Contract Amendment
5.8 Contractor Responsibilities
5.9 Substitution of Staff
5.10 Substitution or Addition of Subcontractor(s)
5.11 Ownership of Material
5.12 Data Confidentiality
5.13 News Releases
5.14 Advertising
5.15 Licenses and Permits
5.16 Claims and Remedies
5.17 Late Delivery and Liquidated Damages
5.18 Retainage
5.19 State's Option to Reduce Scope of Work
5.20 Suspension of Work
5.21 Change in Law
5.22 Additional Work and/or Special Projects
5.23 Form of Compensation and Payment
5.24 Year 2000 Compliance
5.25 Contract Activity Report
1.0 Information for Bidders
1.1 Purpose and Intent
This Notice of Award (NOA) is issued by the Purchase Bureau, Division
of Purchase and Property, Department of the Treasury, on behalf of the
State of New Jersey. The purpose of this contract is to solicit
proposals from qualified bidders for managed care workers compensation
services.
1.2 Background
The Bureau of Risk Management's (BRM) philosophy for managed medical
care services dictates that the organization providing these services
should be "employee-oriented." The injured employee should be treated
with dignity and respect and given the best medical care available.
An HMO approach will not apply to managed medical care for workers'
compensation claims. The ideal managed care organization (MCO) works
with their health care providers to develop informed, medically
appropriate treatment protocols aimed at effectively treating the
injury and returning the employee to a productive capacity at work.
The MCO must be able to provide managed medical care services for the
State of New Jersey's Statewide, self-funded and self-administered
workers' compensation program, including the WorkFirst program,
pursuant to N.J.S.A. 34:15 et. seq. (The WorkFirst program provides a
workers' compensation benefit to citizens who are transitioning from
assistance programs to employment.)
The MCO must be able to provide the services defined herein.
Mandatory MCO responsibilities include:
Operating a Statewide network consisting of a sufficient number of
essential health care providersto meet all other performance
requirements established in this RFP. The phrase "essential
healthcare providers" is defined to include physicians, physical
therapists, pharmacists, psychiatrists, dentists, ophthalmologists,
orthopedics, gastroenterologists, hospitals & related facilities and
any other specialty provider as may be required to treat the injuries
expected of State employees.
Written Protocols dictating appropriate immediate treatment,
treatment plans and the use of related diagnostic procedures for the
injuries expected of State employees.
Essential Health Care Providers who understand workers' compensation
law and the implication of medical treatment on the handling of
workers' compensation claims.
Electronic access to all claim records, medical reports, nurse notes
and other related documentation for every claim under this contract,
both new and takeover. All electronic data interchanges will be
considered, however, Internet access is preferred. Paper copies of
medical records, nurses' notes and other file materials are
unacceptable.
Establish, operate and maintain an Electronic Interface for
reporting of claims and the transfer of provider payments, subject to
BRM & State IT specifications. It is of critical importance that the
communications interface, including all sub-systems, between the MCO
and State's Risk Management Information System be initiated swiftly,
tested rigorously and maintained accurately.
Utilization Review for any medical services provided out of the MCO
network.
Return to Work Programs, with established policies and procedures to
enable the BRM to return an injured employee to work as soon as
medically permissible in light of the employee's medical condition and
job requirements.
3.0 SCOPE OF WORK
At minimum, the MCO must provide the following:
Statewide network consisting of a sufficient number of essential
health care providers. The phrase "essential healthcare providers" is
defined to include physicians, physical therapists, pharmacists,
psychiatrists, dentists, ophthalmologists, orthopedics,
gastroenterologists, hospitals & related facilities and any other
specialty provider as may be required to treat the injuries expected
of State employees.
Written protocols dictating appropriate immediate treatment, treatment
plans and the use of related diagnostic procedures for the injuries
expected of State employees.
Essential Health Care Providers who understand workers' compensation
law and the implication of medical treatment on the handling of
workers' compensation claims.
Electronic access to all claim records, medical reports, nurse notes
and other related documentation for every claim under this contract,
both new and takeover. All electronic data interchanges will be
considered, however, Internet access is preferred. Paper copies of
medical records, nurses' notes and other file materials are
unacceptable.
Establish, operate and maintain an Electronic Interface for reporting
of claims and the transfer of provider payments, subject to BRM &
State IT specifications. It is of critical importance that the
communications interface, including all sub-systems, between the MCO
and State's Risk Management Information System be initialized swiftly,
tested rigorously and maintained accurately.
Utilization Review for any medical services provided out of the MCO
network.
Defined Return to Work Programs, with established policies and
procedures to enable the BRM to return an injured employee to work as
soon as medically possible in light of the employee's medical
condition and job requirements.
In addition, the Managed Care Organization (MCO) shall:
Subject to BRM's special procedures as outlined herein, provide
managed care services for all workers' compensation claims, under this
contract, using the same procedures it typically uses for workers'
compensation claims in the State of New Jersey.
Provide the BRM with real time access to review claim status,
financial records, nurses' notes, medical reports, bills and any other
information as the BRM deems to be essential to the management of the
program.
Precertify all hospital admissions, certain diagnostic procedures (as
identified by the BRM) and outpatient surgery.
Provide an electronic call reporting interface with the BRM's current
telephone reporting system. Claims will be sent to the MCO via the
Internet using FTP protocol, several times throughout the day. MCO is
responsible to build such interfaces as required to accept the State's
transmissions of claims data.
Require each participating health care provider to develop and submit
a treatment plan for the individual to the MCO within 24 hours. The
MCO is required to immediately forward a copy of the plan to the BRM.
The treatment plan must include the following elements:
Accident Date
Accident History as Given by Patient
Pre-existing injury
Physician Comments on Injury Relative to Accident Reported
Modified Duty Specifications
Restrictions-Temporary/Permanent
Length of Time for Restrictions, if Temporary
Job Title and Duties Given by Patient
Prescriptions Given to Employee
State Claim Number
Claimant Name
Claimant Social Security Number
Claimant Date of Birth
Claimant Address
Department, Division and/or Bureau
Diagnosis (ICD-9)
Proposed Course of Treatment
Name and Specialty of Any Referrals
Type(s) of Diagnostic Procedures Recommended
Estimate of Return-to-Work Date
Actual Returned to Work Date (if known)
NOTE: All treatment plans must be made available to the State upon
completion.
Review the treatment plan, apply such protocols as may be appropriate
and have the health care provider resolve any differences within 24
hours. The MCO must have the BRM's prior approval for any significant
deviation from the treatment plan.
Protocols are required for all work-related injuries that can be
reasonably expected to occur within the various work environments of
State operations. These protocols will be available for review by the
BRM upon request. All operations of the essential health care
providers and the staff of the MCO will be guided by the protocols.
The MCO is responsible for any overpayment or incorrect payment made
to a health care provider and any penalty or legal fees associated
with an incorrect payment of bill(s).
NOTE: The BRM retains the right and responsibility to determine the
compensability of any claim, in accordance with the existing workers'
compensation statute. The BRM retains the right not to refer any
claim to the MCO it feels does not or will not benefit from managed
care.
Review all medical and hospital bills to ensure that all treatments
for which a charge is made are for the compensable injury and that
such charges are in accordance with established norms. The MCO is
responsible for any overpayment or incorrect payment made to a health
care provider.
Provide a comprehensive bill audit program which includes
automatically auditing all bills greater than $20,000, screening bills
between $1,000 and $20,000 and routinely auditing an appropriate
sampling of all other bills. Periodic reports of such activity,
including any estimated savings, must be provided to the State of New
Jersey.
Require all health care providers to make recommendations to the BRM
or a State representative, respecting the suitability of a claimant
for alternate or light duty. This may include functional capacity
testing to determine an employee's capability to work.
Identify a designated individual as the Account Manager, who will be
available to the BRM and personnel managers at the various agencies
and locations of the State to provide current information respecting
the status of a claimant, updates on expected return-to-work dates and
any other such information as may be required. Such individual will
be available on a daily basis to act as a liaison and to assist the
BRM and troubleshoot claims issues. The Account Manager will be
required to visit the BRM offices several times each week, on a
regularly scheduled basis.
Assist the BRM and provide such medical and technical advice as may be
required to enable the BRM to determine whether any further medical
treatment is likely to improve the claimant's medical condition. The
MCO will furnish any documentation for such claims, as may be
required.
Conduct account-specific audits for the BRM to ensure 100% processing
accuracy. The results of the audits shall be furnished to the BRM on
a quarterly basis.
Maintain all individual employee records by employee Social Security
Number.
Provide on a daily basis, via an electronic data interchange, all
medical claim transactions.
Provide yearly cost projections and budget documents, as may be
required, to the BRM. These will be requested by the BRM on an annual
basis and shall be provided within 30 days of the request.
Establish an electronic interface for provider payments. The
interface will run through the BRM Risk Management Information System.
The contractor will be solely responsible for monthly reconciliation
of the account, for resolving outstanding items and for maintaining
satisfactory controls/audits of the payment process. The BRM will
assume responsibility for the availability of funds sufficient to
satisfy the obligations generated as a result of the medical
treatment.
Prepare any and all reports, which may be required by any governmental
agency. The MCO must send separate statements to providers of medical
services, furnishing information as required by the IRS and
regulations thereunder regarding amounts paid to those providers of
services.
The MCO is solely responsible to maintain, for all its essential
health care providers, the necessary documents (i.e. W-9's) to enable
each provider to be paid by the State.
Deliver financial accounting reports each month at the Operations
Meeting and cumulatively for the year, within 60 days of the close of
the state's fiscal year. These reports include the basic claim
activity reports, medical claim service reserve estimates and other
reports that have been agreed upon, that summarizes annual claim and
expense data.
Maintain a claims data history for all claims, both open and closed on
the MCO's computer system. All claims data will be available to the
Bureau.
In the event the State transfers claim administration responsibilities
to another vendor, the successful bidder agrees to provide, within 90
days, claim history file, with certain data elements. Including, but
not limited to, claimant name, social security number, date of claim,
authorized treating medical records, payment history and any other
claims records deemed necessary by the State of New Jersey. The MCO
must agree to make every effort to cooperate with the successor and
the BRM in order to facilitate the transition.
The MCO is responsible for the professional quality, technical
accuracy, timely completion and delivery of all deliverables and other
services to be furnished under this contract. The MCO shall, without
additional compensation, correct or revise any errors, omissions, or
other deficiencies in its services.
The approval of services furnished here under shall not in any way
relieve the MCO of responsibility for the technical adequacy of its
work. The review, approval, acceptance, or payment for any of the
services shall not be construed as a waiver of any rights under the
agreement or any cause for action arising out of the performance of
this contract.
The MCO's obligations under this clause are in addition to any
expressed or implied obligation under State law and in no way will
diminish any other rights that the State may have against the MCO for
faulty materials, equipment or work.
RIGHTS AND RESPONSIBILITIES OF THE BRM
The following rights are reserved for the State of New Jersey.
The State reserves the right to make the initial referral of the
employee to a network physician.
The MCO will be financially responsible for any overpayment made to
any medical provider. No right of recovery will exist against the BRM
for an overpayment.
The BRM reserves the right to audit, from time to time, all claims,
files, data, medical reports, accounting and claims systems and
related procedures to ensure claims are processed accurately, in
accordance with the contract, N.J.S.A. 34 et seq. and the established
protocols. Audits may be performed by authorized State personnel or
outside parties as directed by the BRM. The MCO, at it own cost and
expense, will provide all necessary data for such audits.
All claim records and supporting documentation; including but not
limited to claimant's authorized treating medical records, are and
will remain the property of the BRM and will be made available as
needed. The BRM reserves the right to determine which records are
needed and when. The MCO agrees to provide the information within a
reasonable time frame and at a reasonable cost.
Installation
The MCO will be solely responsible to conduct the installation
process, also known as the Statewide rollout. The BRM will endeavor
to provide any and all assistance it can, however, cannot guarantee
the availability of its staff for the rollout. Each bidder must
submit to the State details on all related administrative procedures,
forms, IT equipment and supporting materials to be used in the
installation of the managed care program and ongoing administration of
the managed care program. This document is due no later than three
months before the effective date of this program. July 1, 2002 is the
targeted effective date of the program, therefore the plan is expected
to be delivered by April 1, 2002 and rollout is anticipated to begin
as soon as the plan is approved by BRM.
Startup and Conversion
The following functions are to be performed by the successful MCO as
part of initial installation. The descriptions are intended as
clarifications of required work and not as definitions of the
procedures to be used. Part of the evaluation of responses will be
the BRM's assessment of which MCO proposes the most efficient method
of accomplishing the needed functions. Within five (5) days of the
award of the contract resulting from this RFP, the successful bidder
will be required to meet with the BRM to review the implementation
schedule outlined in the MCO's proposal. The MCO must supply an
Implementation Plan outlining the steps, which will be taken to
convert data, perform programming, testing and audits as necessary. A
GANTT Chart must accompany the proposal, outlining all anticipated MCO
and BRM man-hour requirements, covering the period from award of
contract through two (2) months beyond implementation.
Takeover Claims
The MCO is expected to provide managed care services (as defined in
this contract) for all claims incurred on and after the effective date
of this contract and any and all open or re-opened claims held by the
previous MCO including, but not limited to, claimants who require
continuing medical treatment as a result of being judged 100%
permanently and totally disabled by a Judge of Workers' Compensation.
The current population of "takeover claims" totals approximately
3,000.
Documentation and Communication
Staff appointed to the State account will be required to participate
in Monthly Operations Meetings to be held either in Trenton or at the
MCO location. Participants will include the account executive, and the
supervisors for IT Network, Nursing and Claims.
The contractor must also indicate what training and procedures manuals
will be supplied for State Personnel with inquiry/update access to
contractor systems.
Performance Standards
The BRM will include performance standards as part of their contract
with the successful MCO. The standards will define quantified
mutually acceptable financial and account services. The standards
will include but not be limited to:
Appropriate Staffing
Financial Accuracy
On Time Payments
Statistical Coding/Procedural Accuracy
Claims Processing Time
Account Management Satisfaction
Performance in these categories will be a determining factor in the
granting of fee increases.
Network
Participating health care providers (PHCP) may not treat a State
employee without a referral from the MCO.
PHCPs are prohibited from treating an employee outside this contract
and continuing such treatment after a compensable injury, to which
this contract applies, has occurred.
PHCPs must schedule all appointments on a timely basis and communicate
any and all changes with the BRM.
PHCPs are prohibited from treating employees after they have been
released as maximum medical improvement. Participating health care
providers are prohibited from releasing employees in a "PRN" status.
PHCPs may be expected to testify in court regarding appropriateness of
treatment, if requested by the BRM.
A PHCP must accept any legal decision regarding the appropriateness of
treatment, regardless of medical condition of employee.
All PHCP's are required to inform the BRM of any missed appointments.
The PHCP is not permitted to reschedule or postpone any medical
treatment without the expressed consent of the BRM, excepting a
condition which is a recognized medical emergency.
The BRM retains the exclusive right to accept or reject any physician,
in the best interest of the State, regardless of the status of the
physician within the MCO's network. The State retains the right to be
the final arbiter of any difference regarding use of providers. The
State reserves the right not to accept providers within the MCO
network and the MCO is required to identify acceptable replacement
providers, as soon as practicable. Change of provider is not an
acceptable reason for a diminution in service levels.
The MCO must have network coverage throughout the State of New Jersey.
This contract does not contemplate network sharing, leasing or other
such arrangements. Any deviation from this plan must be in writing
and submitted for approval. The BRM retains the right to reject any
network it feels is not comprehensive or is not in the best interests
of the State.
The BRM retains the right at all times to refer a claimant to a
non-network provider. The MCO, upon the request of the BRM, will
provide utilization review services for out-of-network treatment.
The MCO will furnish the BRM with a list of all providers
participating in the network the MCO intends to use for the workers'
compensation program. The BRM, in its sole discretion, shall have the
right to exclude any such provider from the network as it applies to
the BRM.
The contractor will consult with the BRM prior to any proposed changes
in the network which could alter member access to providers or
services, or in any way effect the BRM program, access to medical
care, level of service or related matters.
Hospital contracts, including details of payment arrangements, will be
made available to the BRM upon request, after award of contract. The
Contractor will consult with BRM prior to changes in hospital contract
provisions that could impact the BRM program, access to medical care,
level of service or related matters.
Provider contracts, including the details of payment arrangements,
must be made available to the State of New Jersey upon award of
contract. BRM reserves the right to approve any substantive changes to
any applicable provider contract provisions.
Data Processing Requirements
The BRM's Risk Management Information System (RMIS) currently runs on
an AlphaServer 2100A, utilizing Compaq's True64 UNIX 4.0G Operating
System. The primary programming language is ACCELL 4GL, and the Data
Base, Data Server 7, are products of the Unify Corporation. RMIS
supports the business functions of the Bureau of Risk Management.
The MCO must provide and maintain all communications links and upload
and down load facilities between MCO's system and RMIS.
The MCO, at its sole cost and expense, is responsible to make any
changes to its systems to accommodate BRM systems, including the BRM
and the Attorney General's office.
RMIS will, on a daily basis, except weekends and State holidays,
electronically transfer newly received claims (frst_rpt.data) to the
MCO's site for assignment and processing. The MCO is responsible for
any and all modifications and enhancements to systems to facilitate
the processing and utilization of this file. The MCO must support the
internal and external requirements of RMIS.
The MCO is responsible for the preparation of a weekly electronic
download of all reimbursement requests for network vendor payments
(CSTONJ.INP). RMIS will acquire this file at the MCO's site. The MCO
is responsible for any and all modifications and enhancements to
systems to facilitate the creation and transmission of this file. The
MCO must support the internal and external requirements of RMIS and
the business requirements of the Bureau.
The BRM will process requests for reimbursement through RMIS and the
State's financial system NJCFS. All payments will be transferred from
NJCFS electronically through an ACH to the MCO's account.
The MCO must indicate how it will ensure that only State originated
information/changes will be reflected on State records contained in
MCO's files.
The MCO must provide edits/security to ensure the integrity of the
data on any and all files under the MCO's control.
The MCO must provide analysis/programming as needed to fulfill the
processing requirements of the RFP.
All programs and/or changes to programs, BRM or MCO, must be tested
between the BRM and the MCO's systems prior to implementation.
The MCO must resolve/accommodate all problems/changes required either
by the BRM or changes in the process in a timely manner.
BRM reserves the right to accept or reject all contractors or
subcontractors assigned to this portion of the contract.
The contractor must demonstrate ability to send and receive test files
nightly.
The contractor must provide edits/security to ensure the integrity of
the data on the files.
The contractor must provide analysis/programming as needed to fulfill
processing requirements of the RFP.
The Data Standards to be used are provided as Exhibit III Bureau of
Risk Management Data Standards.
4.0 Reserved
5.0 CONTRACTUAL TERMS AND CONDITIONS
5.1 Precedence of Contractual Terms and Conditions
The contract shall consist of this RFP, addendum to this RFP, the
contractor's bid proposal and the Division's Notice of Acceptance.
Unless specifically noted within this RFP, the Standard Terms and
Conditions take precedence over the Special Terms and Conditions.
In the event of a conflict between the provisions of this RFP,
including the Standard Terms and Conditions and the Special Terms and
Conditions, and any addendum to the RFP, the addendum shall govern.
In the event of a conflict between the provisions of this RFP,
including any addendum to this RFP, and the bidder's proposal, the RFP
and/or the addendum shall govern.
5.2 Performance Bond
This section supplements Section 3.3b of the Standard Terms and
Conditions. A performance bond is required. The amount of the
performance bond is noted on the RFP cover sheet. The performance
bond must be posted within 30 days of the effective date of the
contract award. The performance bond must remain in full force and
effect for the term of the contract and any extension thereof.
5.3 Business Registration
Proof of valid business registration with the Division of Revenue,
Department of the Treasury, State of New Jersey, should be submitted
by the bidder and, if applicable, by every subcontractor of the
bidder, with the bidder's bid. No contract will be awarded without
proof of business registration with the Division of Revenue. Any
questions in this regard can be directed to the Division of Revenue at
(609) 292-1730.
5.4 Contract Term and Extension Option
The term of the contract shall be for a period of four years. The
anticipated "Contract Effective Date" is provided on the cover sheet
of this RFP. If delays in the bid process result in an adjustment of
the anticipated Contract Effective Date, the bidder agrees to accept a
contract for the full term of the contract. The contract may be
extended for all or part of an additional two years, by mutual written
consent of the contractor and the Director.
5.5 Contract Transition
In the event services end by either contract expiration or
termination, it shall be incumbent upon the contractor to continue
services, if requested by the Director, until new services can be
completely operational. The contractor acknowledges its
responsibility to cooperate fully with the replacement contractor and
the State to ensure a smooth and timely transition to the replacement
contractor. Such transitional period shall not extend more than
ninety (90) days beyond the expiration date of the contract, or any
extension thereof. The contractor will be reimbursed for services
during the transitional period at the rate in effect when the
transitional period clause is invoked by the State.
5.6 Availability of Funds
The State's obligation to pay the contractor is contingent upon the
availability of appropriated funds from which payment for contract
purposes can be made. No legal liability on the part of the State for
payment of any money shall arise unless funds are made available each
fiscal year to the Using Agency by the Legislature.
5.7 Contract Amendment
Any changes or modifications to the terms of the contract shall only
be valid when they have been reduced to writing and executed by the
contractor and the Director.
5.8 Contractor Responsibilities
The contractor shall have sole responsibility for the complete effort
specified in the contract. Payment will be made only to the
contractor. The contractor shall have sole responsibility for all
payments due any subcontractor.
The contractor is responsible for the professional quality, technical
accuracy and timely completion and submission of all deliverables,
services or commodities required to be provided under the contract.
The contractor shall, without additional compensation, correct or
revise any errors, omissions, or other deficiencies in its
deliverables and other services. The approval of deliverables
furnished under this contract shall not in any way relieve the
contractor of responsibility for the technical adequacy of its work.
The review, approval, acceptance or payment for any of the services
shall not be construed as a waiver of any rights that the State may
have arising out of the contractor's performance of this contract.
5.9 Substitution of Staff
If it becomes necessary for the contractor to substitute any
management, supervisory or key personnel, the contractor will identify
the substitute personnel and the work to be performed.
The contractor must provide detailed justification documenting the
necessity for the substitution. Resumes must be submitted evidencing
that the individual(s) proposed as substitution(s) have qualifications
and experience equal to or better than the individual(s) originally
proposed or currently assigned.
The contractor shall forward a request to substitute staff to the
State's Contract Manager for consideration and approval. No
substitute personnel are authorized to begin work until the contractor
has received written approval to proceed from the State Contract
Manager.
5.10 Substitution or Addition of Subcontractor(s)
This Subsection serves to supplement but not to supersede Section 3.11
of the Standard Terms and Conditions of this RFP.
If it becomes necessary for the contractor to substitute and/or add a
subcontractor, the contractor will identify the proposed new
subcontractor and the work to be performed. The contractor must
provide detailed justification documenting the necessity for the
substitution or addition.
The contractor must provide detailed resumes of the proposed
subcontractor's management, supervisory and other key personnel that
demonstrate knowledge, ability and experience relevant to that part of
the work which the subcontractor is to undertake.
In the event a subcontractor is proposed as a substitution, the
proposed subcontractor must equal or exceed the qualifications and
experience of the subcontractor being replaced. In the event the
subcontractor is proposed as an addition, the proposed subcontractor's
qualifications and experience must equal or exceed that of similar
personnel proposed by the contractor in its bid proposal.
The contractor shall forward a written request to substitute or add a
subcontractor to the State Contract Manager for consideration. If the
State Contract Manager approves the request, the State Contract
Manager will forward the request to the Director for final approval.
No substituted or additional subcontractors are authorized to begin
work until the contractor has received written approval from the
Director.
5.11 Ownership of Material
All data, technical information, materials gathered, originated,
developed, prepared, used or obtained in the performance of the
contract, including, but not limited to, all reports, surveys, plans,
charts, literature, brochures, mailings, recordings (video and/or
audio), pictures, drawings, analyses, graphic representations,
software computer programs and accompanying documentation and
print-outs, notes and memoranda, written procedures and documents,
regardless of the state of completion, which are prepared for or are a
result of the services required under this contract shall be and
remain the property of the State of New Jersey and shall be delivered
to the State of New Jersey upon 30 days notice by the State. With
respect to software computer programs and/or source codes developed
for the State, the work shall be considered "work for hire", i.e., the
State, not the contractor or subcontractor, shall have full and
complete ownership of all software computer programs and/or source
codes developed.
5.12 Data Confidentiality
All financial, statistical, personnel and/or technical data supplied
by the State to the contractor are confidential. The contractor is
required to use reasonable care to protect the confidentiality of such
data. Any use, sale or offering of this data in any form by the
contractor, or any individual or entity in the contractor's charge or
employ, will be considered a violation of this contract and may result
in contract termination and the contractor's suspension or debarment
from State contracting. In addition, such conduct may be reported to
the State Attorney General for possible criminal prosecution.
5.13 News Releases
The contractor is not permitted to issue news releases pertaining to
any aspect of the services being provided under this contract without
the prior written consent of the Director.
5.14 Advertising
The contractor shall not use the State's name, logos, images, or any
data or results arising from this contract as a part of any commercial
advertising without first obtaining the prior written consent of the
Director.
5.15 Licenses and Permits
The contractor shall obtain and maintain in full force and effect all
required licenses, permits, and authorizations necessary to perform
this contract. The contractor shall supply the State's Contract
Manager with evidence of all such licenses, permits and
authorizations. This evidence shall be submitted subsequent to the
contract award. All costs associated with any such licenses, permits
and authorizations must be considered by the bidder in its bid
proposal.
5.16 Claims and Remedies
5.16.1 Claims
The following shall govern claims made by the contractor regarding
contract award recision, contract interpretation, contractor
performance and/or suspension or termination.
Final decisions concerning all disputes relating to contract award
recision, contract interpretation, contractor performance and/or
contract reduction, suspension or termination are to be made in a
manner consistent with N.J.A.C. 17:12-1.1, et seq. The Director's
final decision shall be deemed a final agency action reviewable by the
Superior Court of New Jersey, Appellate Division.
All claims asserted against the State by the contractor shall be
subject to the New Jersey Tort Claims Act, N.J.S.A. 59:1-1, et seq.,
and/or the New Jersey Contractual Liability Act, N.J.S.A. 59:13-1, et
seq. However, any claim against the State relating to a final
decision by the Director regarding contract award recision, contract
interpretation, contractor performance and/or contract reduction,
suspension or termination shall not accrue, and the time period for
performing any act required by N.J.S.A. 59:8-8 or 59:13-5 shall not
commence, until a decision is rendered by the Superior Court of New
Jersey, Appellate Division (or by the Supreme Court of New Jersey, if
appealed) that such final decision by the Director was improper.
5.16.2 Remedies
Nothing in the contract shall be construed to be a waiver by the State
of any warranty, expressed or implied, or any remedy at law or equity,
except as specifically and expressly stated in a writing executed by
the Director.
5.17 Late Delivery
The contractor must immediately advise the State Contract Manager of
any circumstance or event that could result in late completion of any
task or subtask called for to be completed on a date certain. If the
contractor cannot meet the contract completion date for any task or
subtask required to be completed by a date certain, the contractor
shall be liable to the State for damages incurred.
5.18 Retainage
The amount of retainage is noted on the RFP cover sheet. The Using
Agency shall retain the stated percentage of each invoice submitted.
At the end of each three (3) month period, the Using Agency shall
review the contractor's performance. If performance has been
satisfactory, the Using Agency shall release 90% of the retainage for
the preceding three-(3) month period. Following certification by the
State Contract Manager that all services have been satisfactorily
performed, the balance of the retainage shall be released to the
contractor.
5.19 State's Option to Reduce Scope of Work
The State has the option, in its sole discretion, to reduce the scope
of work for any task or subtask called for under this contract. In
such an event, the Director shall provide advance written notice to
the contractor.
Upon receipt of such written notice, the contractor will submit,
within five (5) working days to the Director and the State Project
Manager, an itemization of the work effort already completed by task
or subtask. The contractor shall be compensated for such work effort
according to the applicable portions of its cost proposal.
5.20 Suspension of Work
The State Contract Manager may, for valid reason, issue a stop order
directing the contractor to suspend work under the contract for a
specific time. The contractor shall be paid until the effective date
of the stop order. The contractor shall resume work upon the date
specified in the stop order, or upon such other date as the State
Contract Manager may thereafter direct in writing. The period of
suspension shall be deemed added to the contractor's approved schedule
of performance. The Director and the contractor shall negotiate an
equitable adjustment, if any, to the contract price.
5.21 Change in Law
Whenever an unforeseen change in applicable law or regulation affects
the services that are the subject of this contract, the contractor
shall advise the State Contract Manager and the Director in writing
and include in such written transmittal any estimated increase or
decrease in the cost of its performance of the services as a result of
such change in law or regulation. The Director and the contractor
shall negotiate an equitable adjustment, if any, to the contract
price.
5.22 Additional Work and/or Special Projects
The contractor shall not begin performing any additional work or
special projects without first obtaining written approval from both
the State Contract Manager and the Director.
In the event of additional work and/or special projects, the
contractor must present a written proposal to perform the additional
work to the State Contract Manager. The proposal should provide
justification for the necessity of the additional work. The
relationship between the additional work and the base contract work
must be clearly established by the contractor in its proposal.
The contractor's written proposal must provide a detailed description
of the work to be performed broken down by task and subtask. The
proposal should also contain details on the level of effort, including
hours, labor categories, etc., necessary to complete the additional
work.
The written proposal must detail the cost necessary to complete the
additional work in a manner consistent with the contract. The written
cost proposal must be based upon the hourly rates, unit costs or other
cost elements submitted by the contractor in the contractor's original
bid proposal submitted in response to this RFP. Whenever possible,
the cost proposal should be a firm, fixed cost to perform the required
work. The firm fixed price should specifically reference and be tied
directly to costs submitted by the contractor in its original bid
proposal. A payment schedule, tied to successful completion of tasks
and subtasks, must be included.
Upon receipt and approval of the contractor's written proposal, the
State Contract Manager shall forward same to the Director for the
Director's written approval. Complete documentation from the Using
Agency, confirming the need for the additional work, must be
submitted. Documentation forwarded by the State Contract Manager to
the Director must all include all other required State approvals, such
as those that may be required from the State of New Jersey's Office of
Management and Budget (OMB) and Office of Information and Technology
(OIT).
No additional work and/or special project may commence without the
Director's written approval. In the event the contractor proceeds
with additional work and/or special projects without the Director's
written approval, it shall be at the contractor's sole risk. The
State shall be under no obligation to pay for work done without the
Director's written approval.
5.23 Form of Compensation and Payment
This Section supplements Section 4.5 of the RFP'S Standard Terms and
Conditions. The contractor must submit official State invoice forms
to the Using Agency with supporting documentation evidencing that work
for which payment is sought has been satisfactorily completed.
Invoices must reference the tasks or subtasks detailed in the Scope of
Work section of the RFP and must be in strict accordance with the
firm, fixed prices submitted for each task or subtask on the RFP
pricing sheets. When applicable, invoices should reference the
appropriate RFP price sheet line number from the contractor's bid
proposal. All invoices must be approved by the State Contract Manager
before payment will be authorized.
Invoices must also be submitted for any special projects, additional
work or other items properly authorized and satisfactorily completed
under the contract. Invoices shall be submitted according to the
payment schedule agreed upon when the work was authorized and
approved. Payment can only be made for work when it has received all
required written approvals and has been satisfactorily completed.
5.23
Not applicable to this procurement.
5.24
Not applicable to this procurement.
5.25 Contract Activity Report
In conjunction with the standard record keeping requirements of this
contract, as listed in paragraph 3.19 of this RFP'S standard terms and
conditions, contractor(s) must provide, on a calendar quarter basis,
to the Purchase Bureau buyer assigned, a record of all purchases made
under their contract award resulting for this Request for Proposal.
This includes purchases made by all using agencies including the State
and political sub-divisions thereof. This reporting requirement
includes sales to State using agencies and, if permitted under the
terms of the contract, sales to counties, municipalities, school
districts, volunteer fire departments, first aid squads and rescue
squads, and independent institutions of higher education. The
requirement also includes sales to State and County Colleges and
Quasi-State Agencies. Quasi-State Agencies include any agency,
commission, board, authority or other such governmental entity which
is established and is allocated to a State department or any bi-state
governmental entity of which the State of New Jersey is a member.
This information must be provided in a tabular format such that an
analysis can be made to determine the following:
-Contractor's total sales volume under contract, subtotaled by
product.
-Contractor's total sales volume to each purchaser under the contract,
subtotaled by product, including, if applicable, catalog number and
description, price list with appropriate page reference and/or
contract discount applied
Submission of purchase orders, confirmations, and/or invoices do not
fulfil this contract requirement for information.
Contractors are strongly encouraged to submit the required information
in electronic spreadsheet format. The Purchase Bureau uses Microsoft
Excel.
Failure to report this mandated information will be a factor in future
award decisions.
INDEX NO: T1997
PAGE NO: 3
VENDOR INFORMATION SHEET
COOP *
VENDOR NAME AND ADDRESS SBE/MBE/WBE/PURCH
______________________________________________________________________________
HORIZON CASUALTY SERVICES INC NO /NO /NO /NO CONTRACT #: 51467
33 WASHINGTON ST/11TH FL EXPIRATION DATE: 12/31/09
NEWARK, NJ 07102 TERMS: NONE
DELIVERY: 30 DAYS ARO
CONTACT PERSON: ILEENE WACHS CONTACT PHONE: 973-622-0100
ORDER FAX # : 973-622-7353
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
INDEX NO: T1997
PAGE NO: 4
CONTRACT ITEMS/SERVICES
BY VENDOR
______________________________________________________________________________
VNDR: HORIZON CASUALTY SERVICES INC CNTRCT #: 51467
LINE# DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE: 958-61-044147 1.000 EACH N/A $443.07000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. ANNUAL RATE YEAR 1.
00004 COMM CODE: 948-46-045190 1.000 EACH N/A $419.00000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. ANNUAL RATE YEAR 2.
00005 COMM CODE: 948-46-045191 1.000 EACH N/A $440.00000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. ANNUAL RATE YEAR 3.
00006 COMM CODE: 948-46-045192 1.000 EACH N/A $462.00000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. ANNUAL RATE YEAR 4.
00007 COMM CODE: 958-61-044147 1.000 EACH N/A $425.37000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. PRICE PER CLAIM FOR SIX MONTH
CONTRACT EXTENSION FROM JULY 1, 2006
THROUGH DECEMBER 31,2006. PRICE REFLECTS
2.5% INCREASE.
00008 COMM CODE: 958-61-044147 1.000 EACH N/A $454.15000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. PRICE PER CLAIM FOR SIX MONTH
CONTRACT EXTENSION FROM JULY 1, 2007
THROUGH DECEMBER 31,2007. PRICE REFLECTS
2.5% INCREASE.
00009 COMM CODE: 958-61-044147 1.000 EACH N/A $454.15000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. PRICE PER CLAIM FOR SIX
MONTH CONTRACT EXTENSION FROM
JULY 1, 2008 THROUGH DECEMBER 31, 2008
PRICE CONTINUES TO REFLECT 2.5%
INCREASE.
00010 COMM CODE: 958-61-044147 1.000 EACH N/A $454.15000
MANAGED CARE WORKERS' COMPENSATION
SERVICES. PRICE PER CLAIM FOR TWO
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