Search

ATTACHMENT B
CONTRACTING PROVIDER COMPENSATION PROVISIONS

For Covered Services provided by Contracting Providers in accordance with the
terms and conditions of the Plan and the provisions of agreements through which HPHC
has arranged for the provision of Covered Services to Members, Purchaser shall provide
compensation in the amounts charged at the rate to which each Contracting Provider, or
an entity acting on the Contracting Provider's behalf, has agreed with HPHC or HPHC’s
designee. Purchaser understands that HPHC has a variety of agreements with
Contracting Providers relating to compensation arrangements for self-insured plans
administered by HPHC. These arrangements include, but are not limited to, withholds,
risk-sharing, vendor rebates/refunds, capitation, per diem paymenis, fee schedules and
DRGs. These arrangements are for the sole benefit of HPHC and Purchaser shall have
no interest in or claim on any of these arrangements, except to the extent that HPHC
has determined, in accordance with its reimbursement practices and procedures relating
to self-insured plans, to make such arrangements partiaily available to self-insured
plans. Purchaser acknowledges and agrees that HPHC has not represented or
guaranteed that Purchaser will receive the same reimbursements arrangement that
would apply to HPHC's insured business. Claims paid under the Plan shall be
determined and calculated on the basis of the foregoing rates of payment, for purposes
of Attachment D. Ail payments to providers shall be subject to the applicable
copayments and deductibles under the Plan.

Primary Care Providers, as defined in Attachment E, may be paid a monthly
management Fee for each member enrolled in his or her practice in addition to
compensation for Covered Services rendered. HPHC may amend the Managerient Fee
by thirty-days advance written notice to Purchaser.

Contracting Providers shall accept the above compensation as payment in full for .
Covered Services, except for applicable copayments and coinsurance.

FORM# PS_B01 i 05/17/2002

ATTACHMENT C
HPHC COMPENSATION PROVISIONS

Purchaser shall pay HPHC on the first day of each month a Service Fee
described below. In return for this monthly Service Fee from Purchaser during the term
of the Purchaser Service Agreement and for one (1) year thereafter, HPHC shall process
and pay all eligible claims incurred during the term of the Agreement for a period up to
twelve (12) months after termination of the Agreement. There will be periodic retroactive
and prospective adjustments to such payments to reflect the actual number of covered
contracts and prorated portions thereof. HPHC shall provide the Purchaser or its
Designee with a monthly bill for administrative services. All HPHC administrative
services are included in this Service Fee except as specifically excluded in paragraph 10
of Attachment A or as specifically provided in the Purchaser Service Agreement.

Administrative Fee Schedule

Product Name Individual - Dual Family
Contract Contract Contract
EPO $27.50 $55.00 $74.25

FORM# PS_CO1 05/17/2002

ATTACHMENT D
FUNDING OF COVERED SERVICES

OVERVIEW: HPHC shali from time to time, generally at weekly intervals, issue
payment to Contracting Providers for Covered Services. HPHC makes such
payments from a master claims paying account. This Attachment describes the
manner in which the Purchaser provides sufficient funds to HPHC to cover such
payments. Purchaser understands that failure to make sufficient funds available
in accordance with this Attachment shall cause HPHC to suspend further claims.

payments.

WEEKLY TRANSFER WITH PURCHASER AS ORIGINATOR: Purchaser has
agreed to reimbursement through weekly wire transfer with Purchaser as the
originator, HPHC will invoice Purchaser each week by Friday. Unless otherwise
agreed, the invoice will be in the form of a fax. Each invoice will include all claims
that were paid on Tuesday of that week from the HPHC master claims paying
account. Purchaser shall wire the amount due to HPHC by the third business day
following notification. This form of reimbursement requires that Purchaser make
an initial working deposit equal to one half of a month’s anticipated claims
expense as calculated by HPHC. The working deposit shall be kept in a
segregated sub-account specific to Purchaser maintained by HPHC at Citizens
Bank. HPHC acts as the custodian of the sub-account. A “W-9 Form” must be
filled out by Purchaser to establish the sub-account. Interest earned at the
current bank interest rate will be added to the working deposit. Each plan year,
HPHC will recalculate the working deposit required based on current utilization

and membership.

MONTHLY STATEMENT: Each month, HPHC shail provide a statement to the
Purchaser, which will include all claims paid and all payments received within the
month. This report will include detailed reports that support the claims charges on

the monthly billing statement.

DUTIES ON TERMINATION: Pursuant to section 3.8 of the Agreement, HPHC
shall process and pay all eligible claims incurred during the term of this
Agreement for a period up to twelve (12) months after termination of the
Agreement, and Purchaser shall continue to provide funding for such claims
payments in accordance with this Attachment.

Form# PS_4D01 05/17/2002

ATTACHMENT LIST

Attachment A Administrative Services

Attachment B Contracting Provider Compensation
Provisions

Attachment C HPHC Compensation Provisions

Attachment D Funding of Covered Services

Attachment E Purchaser's Plan

FORM#PS01 . 05/17/2002
1

ATTACHMENT A
ADMINISTRATIVE SERVICES

HPHC shail perform the following administrative services for Purchaser with
. respect to the Plan.

- 4. Financial Systems and Services. HPHC shall establish, administer and
maintain accounting procedures and systems for the preparation of appropriate financial
reports for the efficient management and planning for the Plan. The foregoing shall

include, but not be limited to:

(a) Not later than ninety (90) days prior to the beginning of each annual
contract period, HPHC shail prepare and provide the Purchaser with
an annual operating budget setting forth an estimate of the Plan’s
operating expenses for the contractual year which shall be in
reasonable detail and shall contain an explanation of anticipated
changes, if any, in utilization, claims paid, and other factors which
may significantly affect the operating budget.

(b) HPHC shall assist Purchaser on Purchaser's request in preparing
and filing all financial reports required of Purchaser regarding the
Plan by any federal, state or other agency or authority.

(c) HPHC will provide the Purchaser monthiy accounting statement,
standard support reports, working fund billing services, and up to ten
(10) hours per year of personnel support for audits. Comprehensive
audits of claims data covering a multiple year period require a 45
day notice. HPHC will accommodate non standard report requests
subject to available staffing capacity and will reserve the right to
charge one hundred dollars ($100) per hour for labor costs, and a
set up fee of one hundred dollars ($100.00) per hour for
programming costs and seventy-five dollars ($75.00) per hour for
installation costs associated with each request. Audit support in
excess of ten (10) hours per year will be charged at one hundred
dollars ($100) per hour for each request.

2. Claims Processing and Administration. Subject to the restrictions in
Section 2(c) below, HPHC shall design, implement and maintain such systems and
procedures as may be necessary for the appropriate adjudication and timely payment of
all claims for payment submitted to Purchaser (including Member and provider claims)
and to assure the availability of appropriate and accurate information for the
administration of the Plan's programs. HPHC's services shall include, but not be limited

to the following:

FORM# PS_AO1 05/17/2002

(a)

(b)

(c)

(d)

(e)

Drafting or specifying all documents, forms and records to be used
by Contracting Providers for their claims of reimbursement and to be
used by HPHC to reimburse them and also to develop procedures
to be utilized in the adjudication of claims;

Evaluating and processing all claims for payment submitted to
HPHC under the Plan. HPHC shail investigate reported health care
claims in the manner and to the extent necessary and supervise a
settlement of those health care claims and other demands that the
Plan is legally obligated to pay; prepare checks or drafts drawn
again the Purchaser’s funds allocated to the Plan to settle such
claims or demands; and maintain claim files for the Plan; and

Utilization and Peer Review. HPHC shall maintain systems, trained
staff and procedures necessary or appropriate for the operation of a
reasonable and appropriate utilization review and quality assurance
program that meets generally accepted standard and which reviews
services required under the Plan. Utilization/Case Management
Services included but are not limited to: prior authorization,
precertification, concurrent and retrospective utilization review,
discharge planning, physician review of denials and appeals,
specialty case management, and disease management programs.

In all cases, using its best efforts to advise Purchaser of any
disputed health care claims by Members over which litigation has
been commenced or threatened or which is reasonably iikely to
result in litigation, HPHC will follow its standard practices for
resolving such claims. HPHC shall also refer to Purchaser any
other health care claims where the facts available to HPHC do not
provide adequate basis for resolution of the claim by HPHC and
determination of the claim may involve the exercise of discretion. In
all such disputed or unresolved cases, the ultimate authority to
resolve such claims is expressly retained by Purchaser and
Purchaser expressly retains the authority to make the ultimate
decision with regard to such claims. Purchaser also retains the
authority to decide whether an investigation of any disputed claim is
to be conducted and, if so, the extent of that investigation.

HPHC will administer the grievance and appeals procedure for
Members as described in Attachment E.

Lh.

3. Benefits Adminstration. HPHC will appropriately administer the
Purchaser's Benefit Option Code (BOC) as selected by the Purchaser. Any Level 1 or
Level 2 benefit package not covered by an existing BOC will be charged a set up fee of
one hundred dollars ($100.00) per hour for programming costs and seventy-five dollars
($75.00) per hour for installation costs associated with each request

4. Contracting Provider and Member Service Records. HPHC shall design,

implement and maintain the following services related to Contracting Provider and
Member services and records:

FORM# PS_AQ1

05/17/2002

(a)

(b)

(c)

(d)

HPHC shall assist Purchaser in preparing and distributing to
Members appropriate Member identification cards, instructional
brochures, booklets, announcements, and disclosure statements as
may be reasonably necessary and/or required by law, to assure the
availability of accurate and appropriate information regarding the
healih care services to be provided and the administration and
operations of the Pian’s programs. Upon request of the Purchaser,
customized member materials will be charged to the Purchaser at

cost.

HPHC shall develop and provide information for distribution to
Contracting Providers as may be reasonably necessary and/or
required by law to fully describe billing procedures, payment for
services, and the schedule of Covered Services. Such costs, as
well as all costs associated with the development and maintenance
of a network that meets Purchaser’s requirements as specified
herein shail be borne by HPHC:

HPHC shail develop and maintain Member and provider files to
permit eligibility verification, rate and provider compensation
computations, claims adjudication and efficient and timely response
to inquiries from Members and providers. HPHC shall be
responsible for informing Members in a timely fashion of the lapse
or termination of their eligibility to receive Covered Services. tn
accordance with Section 2.6 and 2.7 of the Purchaser Service
Agreement, HPHC may rely on information regarding the eligibility
of Members provided by Purchaser.

HPHC shall provide to the Purchaser a monthly administration bill
with membership roster. HPHC will accommodate billing.
reconciliation requests subject to availiable staffing capacity and will
reserve the right to charge one hundred dollars ($100) per hour for

labor costs.

5, Information Systems. HPHC shall employ an information system
appropriate for the purposes of claims processing, provider compensation computation,
utilization review, quality assessment, eligibility of Members, billing and making required
reports to regulatory agencies. HPHC shail bear all reasonable costs associated with the
acquisition and maintenance of the information system, including purchase or lease of
equipment, hardware and software development, installation, maintenance and
modification, and computer time- sharing and all personnet costs. The system, including
all software programs related thereto, shall be proprietary to HPHC or its contractor,

FORM# PS_A01

08/17/2002

FORM# PS_A0O14

Reports.

(a)

(b)

(d)

(a)

(a)

HPHC shall assist Purchaser, upon Purchaser’s request, in
providing such reports as may be required by any regulatory agency
having jurisdiction over the operations of the Plan including, to the
extent applicable, the U.S. Department of Labor (including Form
5500 and Summary Annual Report), the Internal Revenue Service,
and state governmental agencies. HPHC shall, upon Purchaser's
request, comply on Purchaser's behalf, with the New York Health
Care Reform Act reporting requirements.

HPHC shall report, at Purchaser's request, concerning the activities
of the Plan as shall be reasonably necessary for Purchaser, its
officers and directors, to fulfill their corporate or governmental
responsibilities.

HPHG shall provide reports to Purchaser, upon Purchaser’s request ”
on a schedule as indicated below:

HPHC will provide reinsurance notifications and filings as outlined in
the HPHC Reinsurance Guidelines to the reinsurance carrier as
noted in the Purchaser’s Stop Loss Policy (Attachment G). HPHC
will accommodate non standard requests subject to available
capacity and will reserve the right to charge one hundred dollars
($100.00) per hour for labor costs and a set up fee of one hundred
dollars ($100) per hour for programming costs and seventy-five
dollars ($75.00) per hour for installation costs associated with each

request.

Monthly

A monthly paid claims report including member identification
number, incurred date or date of service, service paid date/monih,
type of claims (hospital, medical or drug), type of service
description, provider number, total amount paid. All claims, including
prescription drug claims, shail be included. This report shall be
provided in an accepted electronic media format to the Purchaser or
its Designee, which acceptance shall not be unreasonably withheld,

Quarterly

On a quarterly basis or when reasonably requested by Purchaser,
HPHC shall furnish Purchaser with reports regarding the utilization
and cost of health services and supplies rendered to Members by
providers of these services. Such reports shall include, but not be
limited to, eligibility data and information regarding the types and
costs of services rendered and the frequency with which each type
of service was performed. HPHC will accommodate non standard
requests subject to available staffing capacity and will reserve the
right to charge one hundred dollars ($100) per hour for labor costs

05/17/2002

7.

(b)

(a)

and a set up fee of one hundred dollars ($100.00) for programming
costs and seventy-five dollars ($75.00) per hour for installation costs
associated with each request.

A quarterly report of enrollment status and activity by individual and
family subscriber, by group (may be provided in the form of a
monthly invoice for administration fees).

Annually

At least sixty (60) days prior to renewal, HPHC shall present to
Purchaser or its Designee a renewal package that contains: (a) a
detailed claims projection by plan type for the next policy period and
(b) proposed fully incurred administrative fees. Any affect ofthe
renewal package on the Funding of Covered Services (see
Attachment D) will be communicated to Purchaser or its Designee
after Purchaser’s annual open enrollment period.

Government Regulation. HPHC shall use reasonable efforts, within the

scope of its authority and responsibilities hereunder, to ensure that the Plan complies
with the requirements of any applicable state or federal statute, ordinance, law, rule, ’
regulation, or order of any governmental or regulatory body having jurisdiction over the
Plan. The Plan itself, however, is responsible for compliance with all applicable laws.

8.

FORM# PS_A01

(a)

(b)

(c)

Deposit and Disbursement of Funds.

HPHC shall maintain an accouniing of all monies received from
Purchaser or otherwise arising from the operation of the Plan and
shall make disbursements on behalf of the Plan in such amounts
and at such times as the same are required. HPHC shall maintain
and retain records clearly reflecting all transactions made for the
Plan and shall furnish such records to Purchaser, at Purchaser's

request.

HPHC shail serve as Purchaser's true and lawful attorney-in-fact to
bill and collect such amounts as may be payable to the Purchaser
for the Plan; to collect in the Purchaser's name accounts receivable
generated by such billing; and to take possession of and endorse in
Purchaser's name any cash, notes, checks, money orders,
insurance payments, and any other instruments received in
payment.

Upon termination of this Agreement, HPHC will continue to pay
claims (not including taxes or other governmental obligations as
described in section 10(c) below) incurred through the effective date
of termination, for a period not to exceed twelve (12) months (the
“run-out period”) on the condition that Purchaser continue to provide
funding for such claims payments in the same manner as is required
during the contract period. HPHC may charge interest in the
amount of fifteen percent (15%) annually on amounts which

05/17/2002

To:

From:

Re:

B. Motion:

Attachments:

Discussion:

City of Nashua, Public Works Division

Board of Public Works Meeting Date: March 24, 2022

David L. Boucher, Superintendent
Wastewater Department

Digester Heat Exchanger and Stair Tower Exhaust Fan — Design Phase Services

To approve the contract with Wright Pierce to provide design plans and
specifications for a second digester heat exchanger and stair tower exhaust fan in
an amount not to exceed $40,900. Funding for this contract will be through
Department: 169 Wastewater; Fund: Wastewater; Activity: Heat Exchanger
Primary Digester.

Wright Pierce Scope of Work and Fee Schedule

The Primary Digester has a heat exchanger in the bottom level that heats sludge to
the proper temperature to keeps the digester running optimally. Currently there is
one heat exchanger in place. The wastewater facility has purchased a second heat
exchanger for redundancy, which will allow us to maintain the digestion process
should one exchanger become faulty or needs to be taken off-line for routine
maintenance. This project involves containment modifications, additional piping
and controls for the installation of the second heat exchanger.

There is an enclosed stair tower that provides access to the top of both the primary
and secondary digesters. At the very top of the stair tower is an exhaust fan that is
not working and difficult to access and repair as it is located on the roof of the
stair tower. A much safer approach is to abandon the existing fan and install a
new one at the top of the stair tower, below the roof level, so that it can safely be
reached by employees when servicing.

Both of these projects are in the same general location and it makes economical
sense to lump both projects into one. Wright Pierce has satisfactorily completed
many projects at the wastewater plant and we believe they will provide a well
thought out design for each component of this project.