Meeting_Body
FINANCE, BUDGET AND AUDIT COMMITTEE
MAY 19, 2021
Subject
SUBJECT: WORKERS' COMPENSATION UTILIZATION AND PEER REVIEW SERVICES
Action
ACTION: APPROVE CONTRACT AWARD
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to award an eight-year, firm fixed unit price Contract No. PS73428000, to Genex Services, LLC to provide workers' compensation utilization review, peer review, physician consulting and expedited review services in an amount not-to-exceed $400,000 for the four-year base term, effective July 1, 2021 through June 30, 2025, plus $418,180, for the two (2), two-year options, for a total not-to-exceed amount of $818,180 subject to resolution of protest(s), if any.
Issue
ISSUE
Metro's current contract for workers' compensation utilization review services expires June 30, 2021. To ensure workers' compensation utilization review, peer review, physician consulting and expedited review services are able to continue, a new contract must be in effect on July 1, 2021.
Discussion
DISCUSSION
Risk Management's Workers' Compensation Claims Administration unit is a self-insured and self-administered employer for workers' compensation claims. The unit processes thousands of payments monthly for such items as medical services, equipment, pharmaceuticals, legal fees, indemnity benefits and other expenses. Our actuary Aon Risk Services estimates total expenditures for workers' compensation claims payments (excluding the cost of administration) for claims occurring in FY22 will exceed $72 million, with more than a third of these expenditures covering medical costs.
Consistent with industry best practices, we use a variety of techniques to lower our medical expenditures. Such techniques include Bill Review, Utilization Review (UR), Preferred Provider Organizations (PPO) discounts and Nurse Case Management Services.
The California Labor Code makes provisions for insurers and self-insured employers to evaluate the appropriate...
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