City Council
Cody Bass, Mayor
Cristi Creegan, Councilmember
Tamara Wallace, Councilmember
Scott Robbins, Councilmember
Vacant
Mission of the City Council
The City was established to provide essential,
outstanding and cost-effective services that
enhance environmental sustainability, economic
vitality and the quality of life for our residents,
businesses and guests.
City of South Lake Tahoe
City Council and South Tahoe Joint Powers Parking
Financing Authority
Meeting Agenda
Tuesday, September 24, 2024 at 5:30 pm
City Hall - Council Chambers - 1901 Lisa Maloff Way, South Lake Tahoe Public Participation
City Council meetings are held in person at the time and location listed on this agenda. Meetings are live-streamed on Channel 21, City website at www.cityofslt.us, YouTube at https://www.youtube.com/channel/UC3LYne8Ih-kTPLnnuyJW9SQ/live and via ZOOM at this link https://us02web.zoom.us/j/85065832586
A public agenda packet is available for review at City Hall, 1901 Lisa Maloff Way, on the City’s Website at www.cityofslt.us, or by contacting the City Clerk's Office, (530) 542-6005 or [email protected] Providing Public Comment:
In Person: Every agenda for regular meetings provides an opportunity for members of the public to directly address the legislative body (City Council), on any item of public interest which is within the jurisdiction of the City Council during Public Communications. For items on the agenda or in connection with any item which the City Council will consider, the public is given the opportunity to comment before or during the City Council's consideration of the item [Government Code Section 54954.3(a)].
Remote Participation: If you are joining the meeting via ZOOM and would like to make a comment, press the "raise a hand" button. If you are joining the meeting via Channel 21 or live stream and would like to make a comment, please call (530) 542-6500. The meeting ID is: 850 6583 2586. Press *9 to indicate a desire to make a comment. Press *6 to unmute your phone. The Clerk will call you by the last three digits of your phone number when it is your turn to speak. Note: The Mayor reserves the right to conduct the meeting with in-person public participation only, if there is a technology malfunction that precludes the use of remote public participation.
In Writing: Written comments received by 3 p.m. the day before the meeting will be distributed to City Council prior to the meeting. Written public comment regarding any item on this agenda may be sent to [email protected]. When emailing comments, identify the agenda item number in the subject 1 1. Council Member Appointment, Mayor Pro-Tem Selection, and City Council Assignments
2. Presentation by South Tahoe Refuse Regarding 3-Cart Program Implementation line to which your comments relate. Any such comment that is a public record and is emailed to [email protected] or otherwise provided to a majority of the City Council before the meeting will be made available for public inspection during normal business hours at the City Clerk's Office located at City Hall, 1901 Lisa Maloff Way, South Lake Tahoe [Government Code Section 54957.5(b)]. Written comments will not be read out loud during the meeting.
The City Council Chambers meeting facility is accessible to people with disabilities. Every reasonable effort will be made to accommodate any person needing special assistance to attend this meeting.
Contact the City Clerk at (530) 542-6005 at least 48 hours in advance of the meeting for assistance [28 CFR 35.102.35.104 ADA Title II and Brown Act Government Code Sections 54953.2, 54954.1, 54954.2, and 54957.5].
Spanish Interpretations: The public may access Spanish interpretation using the ZOOM link listed on the front of the agenda from an internet device (smartphone, laptop, tablet, home computer) with audio capabilities and selecting the Spanish language option. Persons without an internet device may attend the meeting in-person and a device will be provided while supplies last. Requests for interpreter services to offer public comment may be made by contacting the City Clerk.
Land Acknowledgement
Land Acknowledgement - The City of South Lake Tahoe acknowledges the lands we occupy today are the lands and home of the Wašíšiw, the people from here known today as the Washoe Tribe of Nevada and California, a sovereign nation. Since the beginning of time and for thousands of years before the arrival of any other people, the Washoe lived here and cared for this place, with values and intention that we can all learn from. On behalf of the City Council, I would like to acknowledge, thank, and honor the Indigenous Washoe Tribal Communities that are the past, present, and future stewards of the Lake Tahoe Basin.
Call to Order/Pledge of Allegiance
Roll Call
Regular New Business
Requested Action / Suggested Motions: Receive presentations from applicants. City Council may:
1) Pass a Motion appointing a City Council member to serve former Mayor Pro Tem John Friedrich's remaining term of office until December 10, 2024; 2) Administer of Oath of Office to new City Council member; 3) Pass a Motion selecting a Mayor Pro-Tem to serve until December 10, 2024; and, 4) Pass a Motion selecting City Council members to fill vacant assignments to the Tahoe Regional Planning Agency Governing Board (alternate), Tahoe Transportation District, and three City Council Subcommittees (South Tahoe Public Utilities District 2x2 (alternate), Lake Tahoe Unified School District 2x2, and Multi-Cultural Alliance Subcommittee).
Responsible Staff Member(s): Susan Blankenship, City Clerk Item 1- Executive Summary.pdf
01-Staff Report-Appointment to City Council.docx
02-Applications.pdf
03-2024 City Council Assignments.pdf
Closed Session Report
Presentation
Requested Action / Suggested Motions: Receive presentation by South Tahoe Refuse.
Item 2- Executive Summary.pdf
2 3. City Council Meeting Minutes
4. Fiscal Year 2023-24 Quarterly Financial Status Report - Quarter Ending June 2024
5. Temporary Overlap of Police Officer Position
6. Investment Portfolio Report - June 30, 2024
Public Communications
This is the public's opportunity to speak on any topic NOT LISTED on this agenda. Comments shall be limited to four (4) minutes. In accordance with the Brown Act, the City Council cannot deliberate or vote on any matter raised under public communications, but may briefly respond to statements made or questions posed. (Government Code Sections 54954.2)
City Commission Reports
Consent Agenda
Public Comment - This is the public's opportunity to speak on any topic listed on the Consent Agenda.
Comments shall be limited to three (3) minutes.
The consent agenda consists of items of a repeating or routine nature considered under a single action.
Any Councilmember may have an item on the consent agenda removed and considered separately upon request.
Pass a Motion to adopt the Consent Agenda in one motion except as indicated at each item.
Requested Action / Suggested Motions: Pass a Motion approving the September 10, 2024, Regular City Council meeting minutes and the September 17, 2024, Special City Council meeting minutes.
Responsible Staff Member(s): Susan Blankenship, City Clerk Item 3- Executive Summary.pdf
09 10 2024 City Council Meeting Minutes.pdf
09 17 2024 Special City Council Meeting Minutes.pdf
Requested Action / Suggested Motions: Receive and file.
Responsible Staff Member(s): Andrew Black, Financial Services Supervisor Item 4- Executive Summary.pdf
01-Staff Report-Fiscal Year 2023 24 Quarter End Financial Status Report as of June 2024.docx 02-FY 2023-24 Qtrly Budget Report June 2024.pdf
Requested Action / Suggested Motions: Pass a Resolution authorizing an amendment to the FY 24/25 List of Allocated Permanent Positions increasing Police Officers (excluding cannabis program) from 31 FTE to 31.1 FTEs for a four (4) week overlap of the position in fiscal year 24/25.
Responsible Staff Member(s): Lt. Scott Crivelli
Item 5- Executive Summary.pdf
01-Staff Report - Temporary Overlap of Police Officer Position.docx 02-Resolution - Temporary Overlap of Police Officer Position.docx 03-Position Allocation 24-25 Budget Sep 2024 (Exh. 1 to Reso).pdf Requested Action / Suggested Motions: Receive and File.
Responsible Staff Member(s): Olga Tikhomirova, Director of Finance Item 6- Executive Summary.pdf
01-Staff Report Investment Report June 2024.docx
02-Operations Cash 06 30 2024.pdf
03-Fiscal Agent 06 30 2024.pdf
04-Graph 06 30 2024.pdf
05-Cash June 2024.pdf
3 7. Agreement with LWP Claim Solutions, Inc. for Workers' Compensation Third Party Administrator Services
8. Tahoe Regional Planning Agency and South Lake Tahoe Recreation Facilities Joint Powers Authority funds for Bijou Park Connector Multi-Use Trail Project
9. Sale of Surplus Property
10. Bellamy Parking Garage Equipment Installation Upgrade Project Requested Action / Suggested Motions: Pass a Motion authorizing and directing the Mayor to execute a 5-year Professional Services Agreement with LWP Claim Solutions, Inc., for third-party workers' compensation administration services, for a base cost of $89,000 for year one with 3.5 percent annual increases thereafter.
Responsible Staff Member(s): Rebecca Penado, Risk Manager Item 7- Executive Summary.pdf
01 - WC TPA Staff Report.docx
02 - LWP Professional Services Agreement.pdf
Requested Action / Suggested Motions: Pass a Resolution accepting Tahoe Regional Planning Agency (TRPA) and South Lake Tahoe Recreation Facilities Joint Powers Authority (JPA) funds for Bijou Park Connector Multi-Use Trail Project.
CEQA Determination: Acceptance of funds is not approval of the project under CEQA Guidelines section 15352 because it does not commit the City to a definite course of action. Environmental review is underway.
Responsible Staff Member(s): Stephen Anderjack, Associate Civil Engineer Item 8- Executive Summary.pdf
01-Staff Report - Bijou Park Connector Funding Acceptance.docx 02-Resolution Accepting TRPA and JPA Funds.doc
03 - JPA August Board Meeting Agenda.pdf
04 - TRPA April GB Action Sheet.pdf
Requested Action / Suggested Motions: Pass a Resolution declaring certain vehicles and equipment as surplus and directing the sale of vehicles, equipment and other City assets.
Responsible Staff Member(s): Anush Nejad, Director of Public Works, and Phil Harwood, Fleet Supervisor
Item 9- Executive Summary.pdf
01-Staff Report - Surplus Property.docx
02 - Resolution for Surplus Vehicles.docx
03-Exhibit A to Resolution.pdf
Consent-South Tahoe Joint Powers Parking Financing Authority Requested Action / Suggested Motions: Pass a Resolution authorizing and directing the South Tahoe Joint Powers Parking Financing Authority Chair to execute a contract with Ample Electric, Inc. for $319,040.27, plus 10% contingency of $31,904.00 for the Bellamy Parking Garage Upgrade Project and amending FY 2024/2025 Parking Garage Budget, including appropriating $210,000 from the Parking Garage Fund balance.
CEQA Determination: This action is exempt from review under CEQA Guidelines section 15301 (Existing Facilities).
Responsible Staff Member(s): Anush Nejad, Director of Public Works, and Jeff Roberson, Operations Lieutenant
Item 10- Executive Summary.pdf
01-Staff_Report-Bellamy_Parking_Garage.docx
02-Resolution - Bellamy Parking Garage Installation.docx 03- Ample_Electric_Agreement-F.pdf
Regular-Unfinished Business
4 11. Vision Zero Policy
12. Citizen Appointments to Boards and Commissions
13. Pathways to Removing Obstacles to Housing (PRO HOUSING) Grant Application
14. Memorandum of Understanding with California Tahoe Conservancy for Former Motel 6 Property
15. Contract with California Skateparks for $435,700 for Bijou Park Skatepark Renovation Requested Action / Suggested Motions: Pass a Resolution establishing a Vision Zero Policy toward zero traffic deaths and severe injuries by 2035.
CEQA Determination: This action is statutorily exempt from review under CEQA Guidelines section 15262 (Feasibility and Planning Studies).
Responsible Staff Member(s): Emily Dougherty, Engineering Technician, and Doug Sentell, Lieutenant
Item 11- Executive Summary.pdf
01-Staff Report - Vision Zero Action Plan.docx
02-Resolution - Vision Zero Policy
03-Presentation Vision Zero Policy
Regular-New Business
Requested Action / Suggested Motions: 1) Interview applicant(s); City Council may act on the following or provide direction to the City Clerk; 2) Pass a Motion appointing one member (youth or at large) to fill a vacancy (expires 2/2026) on the Arts, Culture, & Tourism Commission; Direct the City Clerk to continue to solicit applications to the Building Board of Appeals until filled.
Responsible Staff Member(s): Susan Blankenship, City Clerk Item 12- Executive Summary.pdf
01-Staff Report - Citizen Commissions and Boards.docx
02-Morali-Redacted.pdf
03-Notice BBOA ACT.pdf
Requested Action / Suggested Motions: Pass a Resolution authorizing staff to submit a PRO HOUSING Grant application for an amount not to exceed $3,000,000.
Responsible Staff Member(s): Jessica Wackenhut Lomeli, Housing Manager Item 13- Executive Summary.pdf
01-Staff Report - PRO HOUSING Grant Application.docx
02-Resolution-PRO Housing Grant Application.docx
Requested Action / Suggested Motions: Pass a Motion authorizing and directing the Mayor to execute the Memorandum of Understanding with the California Tahoe Conservancy (CTC) for cooperating on the demolition and restoration of the former Motel 6 Property and other properties the CTC may acquire in the future.
Responsible Staff Member(s): Heather Stroud, City Attorney Item 14- Executive Summary.pdf
01 - Staff Report.docx
02 - MOU with California Tahoe Conservancy.pdf
Requested Action / Suggested Motions: Either: (1) Pass a Resolution authorizing and directing the Mayor to execute a contract with California Skateparks for a total of $435,700, allocate $33,785 in additional funds for contingency, materials testing, inspection services and labor compliance reviews and authorizing the FY 2023-2024 budget amendment by transferring a total of $281,314 from the General Fund budgetary savings and reallocated previous commitment to the Skatepark Renovations capital project; or (2) Pass a Motion rejecting bids and directing staff to issue a new request for bids.
CEQA Determination: This action is categorically exempt from review under CEQA Guidelines 15301 (Existing Facilities).
Responsible Staff Member(s): John Stark, Director of Parks & Recreation Item 15- Executive Summary.pdf
5 16. Amendment No. 5 to CDM Smith Professional Services Agreement for Pioneer Trail Pedestrian Improvement Phase II and Acceptance of Tahoe Regional Planning Agency Air Quality Mitigation Funds
17. Ordinance Increasing City Council Compensation (First Reading)
18. Resolution Increasing City Treasurer Compensation
19. Agenda Planning Calendar
01-Staff Report - Skate Park Renovation Project.docx
02-Resolution - California Skateparks Contract and Budget Allocation.docx 03-Contract with California Skateparks (Exh. A to Reso).pdf 04-Presentation Final.pptx
Requested Action / Suggested Motions: (1) Pass a Motion Authorizing and Directing the Mayor to Execute Amendment No. 5 to CDM Smith Professional Services Agreement for an additional $34,558.72 with amended not-to-exceed amount of $560,412.72 for Pioneer Trail Pedestrian Improvement Phase II; and (2) Pass a Resolution accepting and appropriating Tahoe Regional Planning Agency Air Quality Mitigation Funds in an amount of $46,000.
CEQA Determination: The Project is categorically exempt pursuant to CEQA Section 15301(c) (existing facilities consisting of existing streets, sidewalks, bicycle and pedestrian trails, and similar facilities).
Responsible Staff Member(s): Stephen Anderjack, Associate Civil Engineer Item 16- Executive Summary.pdf
01-Staff Report - Amendment-5 Waterline Abandonment Design.docx 02-Resolution- Amendment-5 Waterline Abandonment Design.docx 03-C-226-2024 CDM Smith PSA Amendment 5.pdf
04-GB Item No 3 CSLT Mitigation Request Pioneer Trail Project.docx Requested Action / Suggested Motions: Either Pass a Motion to: 1) Hold a first reading (by title only) of an Ordinance Increasing the City Council Compensation to $1,394.49 per month, effective January 23, 2025, and refer second reading and adoption to the October 22, 2024 meeting; 2) Make no changes to the current compensation; or 3) Direct staff to bring back a revised Ordinance increasing compensation by a lower amount.
Responsible Staff Member(s): Susan Blankenship, City Clerk Item 17- Executive Summary.pdf
01-Staff Report-City Council Compensation.docx
02-Ordinance-City Council Compensation.docx
03-ORD 2022-1169 City Council Compensation.pdf
Requested Action / Suggested Motions: City Council may either: 1) Pass a Resolution increasing City Treasurer compensation to $1,394.49 per month, effective January 23, 2025; 2) Pass a Resolution increasing City Treasurer compensation by a lower amount; or 3) Make no changes to the current compensation.
Responsible Staff Member(s): Susan Blankenship, City Clerk Item 18- Executive Summary.pdf
01-Staff Report - City Treasurer Compensation.docx
02-Resolution - City Treasurer Compensation
03-Resolution 2022-133 City Treasurer Compensation.pdf
Agenda Planning Calendar
Requested Action / Suggested Motions: Identify, with consent of at least two Council members, any desired future agenda items, and/or modify the Agenda Planning Calendar as desired.
Responsible Staff Member(s): Joe Irvin, City Manager and Susan Blankenship, City Clerk Item 19- Executive Summary.pdf
APC - 09 19 2024.pdf
6 Updates and Announcements (City Attorney, City Clerk, City Manager) Councilmember Reports and Comments - Assignments to Boards, Committees, and Commissions
Adjournment
I, Susan Blankenship, City Clerk for the City of South Lake Tahoe, declare that the foregoing agenda for the Tuesday September 24, 2024, City Council and South Tahoe Joint Powers Parking Financing Authority meeting was posted and available for review on Thursday, September 19, 2024, at City Hall, 1901 Lisa Maloff Way, South Lake Tahoe, CA 96150.
The agenda was also available on the City website at https://www.cityofslt.us.
Signed Thursday, September 19, 2024
\\sb\\ Susan Blankenship, Elected City Clerk
7 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:1
Agenda Item: Council Member Appointment, Mayor Pro-Tem Selection, and City Council Assignments Executive Summary: On September 3, 2024, former Mayor Pro Tem John Friedrich submitted his resignation to the City Clerk, effective immediately. Under Government Code section 36512, City Council is required to fill the vacancy within 60 days by appointment or special election. Because there is not time to conduct a special election prior to the end of the term of the former incumbent, the City Clerk solicited for applications to fill the vacancy and received seven applications. In addition to the vacancy on City Council, a Mayor Pro Tem and member assignments may also be selected from Council to serve until December 10, 2024, when these items will next be brought before City Council at the first meeting of the new Council following the November 5 election.
Requested Action / Suggested Motions: Receive presentations from applicants. City Council may: 1) Pass a Motion appointing a City Council member to serve former Mayor Pro Tem John Friedrich's remaining term of office until December 10, 2024; 2) Administer of Oath of Office to new City Council member; 3) Pass a Motion selecting a Mayor Pro-Tem to serve until December 10, 2024; and, 4) Pass a Motion selecting City Council members to fill vacant assignments to the Tahoe Regional Planning Agency Governing Board (alternate), Tahoe Transportation District, and three City Council Subcommittees (South Tahoe Public Utilities District 2x2 (alternate), Lake Tahoe Unified School District 2x2, and Multi-Cultural Alliance Subcommittee).
Responsible Staff Member: Susan Blankenship, City Clerk Reviewed and Approved By: Olga Tikhomirova, Director of Finance Heather Stroud, City Attorney Attachments:
01-Staff Report-Appointment to City Council.docx
02-Applications.pdf
03-2024 City Council Assignments.pdf
8 Council Agenda Report- September 24, 2024 Page 1 of 2 City of South Lake Tahoe
Report to City Council
Meeting Date: September 24, 2024
Title: Council Member Appointment, Mayor Pro-Tem Selection, and City Council Assignments Location: Citywide
Responsible Staff Member: Susan Blankenship, City Clerk Background: On September 3, 2024, former Mayor Pro Tem John Friedrich submitted his resignation to the City Clerk, effective immediately.
Pursuant to Gov. Code 36512(b), “If a vacancy occurs in an elective office provided for in this chapter, the council shall, within 60 days from the commencement of the vacancy, either fill the vacancy by appointment or call a special election to fill the vacancy.” On September 4, 2024, the City Clerk began soliciting applications to fill the vacancy. The term of this Council seat is from the date of appointment for the remainder of the term of office, December 10, 2024. To qualify, candidates must be 18 years of age, reside within the City of South Lake Tahoe, and be registered to vote in the City of South Lake Tahoe at the time the application was submitted.
There exists a vacant Mayor Pro-Tem position on Council and open positions on City Council Assignments; TRPA Governing Board (alternate), Tahoe Transportation District, and three City Council Subcommittees.
Issue and Discussion: The City Clerk received seven (7) applications (Attachment 02- Applications) from qualified candidates for appointment to City Council. Applicants have been asked to make a 3-minute presentation to the City Council. The applicant may then be asked to respond to questions the City Council may have regarding their presentation or application.
City Council may pass a motion appointing a member to serve the remaining term of office until December 10, 2024.
City Council may pass a motion selecting a Mayor Pro Tem to serve until December 10, 2024, when a new Mayor and Mayor Pro Tem will be selected consistent with City Code section 2.05.050 and City Council Protocols.
City Council may pass a motion selecting members to fill Assignments (Attachment 03-Assignments) to the TRPA Governing Board (alternate), Tahoe Transportation District, and three City Council Subcommittees (STPUD 2x2 (alternate), LTUSD 2x2, and Multi-Cultural Alliance Subcommittee). 9 Council Agenda Report- September 24, 2024 Page 2 of 2 Financial Implications: The cost for City Council Compensation for this limited appointment will come from existing City Council Budget.
Environmental Considerations: This action is not a project requiring environmental review under the California Environmental Quality Act (CEQA) under CEQA Guidelines section 15378(b)(5) (organizational or administrative activities that will not result in a direct or indirect physical change in the environment).
Policy Implications: The appointment to office conforms to Government Code. The selection of Mayor Pro Tem and members to fill City Council Appointments conforms to City Council Protocols. 10 11
12 13
14 15
16 17
18 19
20 21
22 23
1 Revised 1/09/2024
2024 City Council Assignments
Set forth by statute:
Board Contact/ Phone Mtg. Schedule/ Place Requirement 2024 Assignment
California Tahoe
Conservancy
Mike Steeves (530) 543-6023
[email protected]
4-6 Meetings per year;
third Thursday every
other month; Alternate
South Shore and North
Shore
Voting Board Member
G.C. Sec. 66906.1
Wallace
Alt: Robbins
Staff Support:
HR
ZT
City Selection
Committee
EDC Board of Supervisors
Kim Dawson (530) 621-5393
[email protected]
As needed
Placerville/TBA
Mayor
G.C. 50270
Bass
Staff Support:
JI
El Dorado Local
Agency
Formation
Commission
(LAFCO)
Shiva Frentzen
(530) 295-2707
[email protected]
Erica Sanchez
Assistant Exec Officer
[email protected]
(530) 295-2707
Fourth Wednesday
every month; 5:30 p.m.
Placerville Apr-Oct CC
Rep participate via
conference call from
Council Chambers for
months of Nov – Mar
Appointment by City
Selection Committee
Appointee (Mayor)
G.C. 56325-56337
2-year term
Wallace
Staff Support:
JI
HS
El Dorado
Countywide
Oversight Board
Susan Blankenship, City Clerk
[email protected]
(530) 542-6005
As needed, general
once a year in January
or February
Appointed by the City
Selection Committee
G.C. 50270
HSC 34179(j)
Wallace
Staff Support:
OT
Tahoe Regional
Planning Agency
Governing Board
----------------
Advisory Planning
Comm
Marja Ambler
(775) 588-4547 x 287
[email protected]
GB Meetings meet
fourth Wednesday
every month; all day
Alternate South Shore
and North Shore
Voting Board Member
G.C. 66800-66801
Term expires 12/2024
Bass
Alt:
Friedrich
Staff Support:
HR
ZT
Susan
Chandler
Tahoe Transportation
District
Judi Allen
(775) 589-5502
[email protected]
Second Friday every
month; Alternate South
Shore and North Shore
Voting Board Member
+Alternate
G.C. 66800-66801
Friedrich
Alt: Bass
Staff Support:
HR
JI
24 2 Revised 1/09/2024
2024 City Council Assignments
Set Forth by Agreement/Joint Powers Agreement/Resolution/Bylaws and/or Past Practice:
Board Contact/ Phone Mtg. Schedule/ Place Requirement 2024 Assignment
JPA - Abandoned
Vehicle Abatement-
(530) 542-6135
(PD-Code Enforcement)
Myriam Cocoletzi
530-542-6136
[email protected]
Required to Hold an
Annual Meeting
Time/Place TBA
Voting Board Member
Must be Elected
Councilmember Agmt
C-68-91
Robbins
Staff Support:
DS
JPA - Cal Tahoe
(California Tahoe Emergency
Services Operations Authority)
Ryan Wagoner, Executive Director
[email protected]
Kayla Galvan, Office Administrator
[email protected]
www.ctesoa.org
Quarterly; Time/Place
TBA
2 Council Appointees
Agmt C-18-10
(1/26/10)
Wallace
Creegan
Alt:Bass
Staff Support:
JD
Clean Tahoe Program Katie Sheehan Third Thursday of the Two Voting Board Wallace 530 544-4210 Month in the City Members Creegan
[email protected] Council Chambers; (Councilmember and Staff Support:
Designee) AN
Clean Tahoe Bylaws HR
El Dorado County
Commission on Aging
Yasmin Hichborn
(530) 642-4833
[email protected]
Third Thursday Every
Month; Rotates Location
Within EDC/TBA;
Council Appointee Keith Roberts
Staff Support:
JS and JI
League of CA Cities-Sac
Valley Division
Charles Anderson
(916) 798-2231
[email protected]
Quarterly Division
Meetings; Annual
Meetings Time/Place
TBA
Council Appointee
(Past Practice =
Mayor)
Robbins
Staff Support:
JI
SB
PADMA Lew Feldman Every other Month 2 Council Appointees Wallace Park Avenue Development
Project Plaza Maintenance
Association
(775) 580-7431
[email protected]
Marriott Grand
Residence
Agmt R-11-00
PADMA Bylaws
Bass
Alt: CM or CA
Staff Support:
JI
HS
South Lake Tahoe
Recreation Facilities
JPA
Bruce Eisner
(530) 545-9905
[email protected]
Shall Hold at Least One
Annual Meeting Each
Year; Time/Place TBA
Board Member Agmt
C-17-00
Robbins
Staff Support:
JS and JI
Community Play Jeff DeFranco 3 times per year Council Appointee Creegan Consortium (530) 541-4660 X 210 Staff Support:
[email protected] JI
OT
JPA -South Lake Tahoe
Basin Waste
Management AuthorityJeffrey Warren
(530) 621-7628
[email protected]
Shall Hold at Least One
Annual Meeting Each
Year; Time/Place TBA
Voting Board
Member-Must be a
Councilmember &
Alternate
Agmt C-25-97
Creegan
Alt: Bass
Staff Support:
AN & SL
25 3 Revised 1/09/2024
Tahoe Prosperity Center Heidi Hill Drum,
(775) 298-0265 (office)
[email protected]
January, April, July,
December
Council Liaison Wallace
Staff Support:
JI
HR
Lake Tahoe Visitor’s
Authority Board
Visit Lake Tahoe
Carol Chaplin [email protected]
(775) 588-5900 x302
Sue Barton (775) 589-2934
[email protected]
Morgan Kern (775) 589-2052
[email protected]
Second Thursday of each
month, 3 p.m.
75 US-50, Stateline, NV
89449
Voting Member
New LTVA Bylaws
Requested from Ms.
Chaplin 12 22 20
Bass
Staff Support:
JI
HR
El Dorado Community
Action Council
(CAC)
Rebecca Johnson
(530) 621-6255
[email protected]
4th Wednesday of each
month at 10:00 a.m.
Council Appointee Chelcee
Thomas
Staff Support
JI
Non-Voting:
2024 City Council Assignments
Board Contact/ Phone Mtg. Schedule/ Place Requirement 2024 Assignments
Tahoe Chamber of Mike Glover, CEO Third Thursday of each Council Liaison – Wallace Commerce (775) 588-1728 x 301 Month; Non-Voting Staff Support:
tahoechamber.org [email protected] 8 a.m./Place TBA (Past Practice) JI HR
South Lake Tahoe Lodging Rich Bodine Second Thursday of each Council Liaison – Wallace Association (530) 543-6515 Month Time/Place TBA Non-Voting (Past Staff Support:
[email protected] Practice) JI
HR
South Tahoe Chamber of Amanda Adams, President Fourth Tuesday of each Council Liaison – Creegan Commerce (530) 721-0243 month Non-Voting Staff Support:
[email protected] (Past Practice) JI
HR
El Dorado County
Transportation Commission
Woodrow Deloria
(530) 642-5265
[email protected]
[email protected]
First Thursday of most
months 2:00 PM in the
EDC Supervisors’
Council Liaison
Non Voting
Bass
Alt. Robbins
Staff Support:
Chambers 330 Fair Lane, HR and JI
Placerville
26 4 Revised 1/09/2024
2024 City Council Appointments to Subcommittees
Name of Committee City Council Appointees (2)
Finance Subcommittee Wallace
Robbins
Staff Support: OT & JI
South Tahoe Public Utility District
1 X 1
(Updated to 1 x 1 01 09 2024)
Robbins
Friedrich (Alt)
Staff Support: JI & SL
Lake Tahoe Unified School District
2 X 2
est. 01 15 2019
Creegan
Friedrich
Staff Support: JI & HR
Lake Tahoe Community College
2 X 2
est. 01 15 2019
Robbins
Wallace
Staff Support: JI & HR
El Dorado County
2 X 2
est. 01 15 2019
Wallace
Bass
Staff Support: JI & HR
Charter City Subcommittee
est. 06 04 2019 (Renamed 12/1/2020)
Bass
Robbins
Staff Support: JI & HR
Housing Subcommittee
est. 01 14 2020
Wallace
Robbins
Staff Support: JW & ZT
Multi-Cultural Alliance Subcommittee
est. 12 15 2020
Friedrich
Bass
Staff Support: JI, DS
Mental Health Subcommittee
est. 08 03 2021
Creegan
Bass
Staff Support: JI & DS
Capital Improvement Program
Subcommittee
est. 01 04 2022
Bass
Creegan
Staff Support: AN
South Shore Transit
Subcommittee
Est. 03 14 2023
Bass
Wallace
Staff Support: JI & HR
27 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:2
Agenda Item: Presentation by South Tahoe Refuse Regarding 3-Cart Program Implementation Requested Action / Suggested Motions: Receive presentation by South Tahoe Refuse. 28 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:3
Agenda Item: City Council Meeting Minutes
Executive Summary: City Council is asked to formally approve the September 10, 2024, Regular City Council meeting minutes and the September 17, 2024, Special City Council meeting minutes.
Requested Action / Suggested Motions: Pass a Motion approving the September 10, 2024, Regular City Council meeting minutes and the September 17, 2024, Special City Council meeting minutes.
Responsible Staff Member: Susan Blankenship, City Clerk Reviewed and Approved By: Susan Blankenship, City Clerk Attachments:
09 10 2024 City Council Meeting Minutes.pdf
09 17 2024 Special City Council Meeting Minutes.pdf
29 City of South Lake Tahoe
City Council
Meeting Minutes
Tuesday, September 10, 2024 at 9:00 a.m.
City Hall - Council Chambers – 1901 Lisa Maloff Way, South Lake Tahoe NOTE: The Meeting Minutes represent actions taken during the meeting of the City Council. Complete Council member discussions on Regular Session meeting items can be viewed in archived video recordings on the City’s website at http://www.cityofslt.us Public submittals on items are retained in the administrative record and can be viewed in the City Clerk’s repository at http://www.cityofslt.us Land Acknowledgement
Mayor Bass read the Washoe Tribe of Nevada and California Land Acknowledgement.
Call to Order/Pledge of Allegiance
Mayor Bass Called the meeting to order at 9:01 a.m., then led the pledge of allegiance.
Roll Call
Present were Mayor Bass and Councilmembers Wallace, Creegan, and Robbins.
Also present were City Manager Irvin, City Attorney Stroud, and City Clerk Blankenship.
Closed Session Report of September 10, 2024
1. Conference with Legal Counsel – Anticipated Litigation, Initiation of Litigation under Gov.
Code section 54956.9(d)(4) (one case).
Action: No reportable action.
2. Conference with Legal Counsel – Existing Litigation – Government Code section 54956.9(d)(1) Case: Cory Wilson v. City of South Lake Tahoe, Workers’ Compensation Appeals Board Case No. ADJ15725631
Action: No reportable action.
Proclamations
1. Proclamation- Suicide Prevention and Recovery Month
Action: Issued a Proclamation to Angie Reagan of Access Tahoe recognizing September 2024 as "Suicide Prevention and Recovery Month".
2. Proclamation- Constitution Week
Action: Issued a Proclamation to the Daughters of the American Revolution recognizing September 17-23, 2024, as “Constitution Week”
09 10 2024 CC Minutes
30 Public Communications
Public Comment was heard from the following people:
1. JT Davis, Tahoe Valley Elementary- Request for Councilmembers to attend upcoming Walkathon event.
2. Kenney Curtzwiler- American Legion membership
3. John Messina- 3-cart trash system *submitted video portraying cart use
4. Scott Loberg- 3-cart trash syste
5. Ed Mosur- Promise to mother for obtainnig a real estate license
6. Eric Asberry- City Council vacancy, Sunray Motel, Heavenly Parking Agreement, Measure N, Support for Roberts and Jinkens City Council candidacy
Written Public Comment was received from the following people:
1. Kelly O’Haire- Hazmat Spill
2. Evan Bevan- City Clerk Blankenship
3. James Bramston- City Clerk Blankenship
4. Saundra Edwards- Councilmemeber Wallace
5. Paul Geske- City Clerk Blankenship
City Commission Reports
None.
Consent Agenda
Action: Moved/Seconded: Wallace/Creegan
Yes: Bass, Creegan, Wallace, Robbins
Note: Robbins recused himself from voting on item 10 due to real property interest in the area.
Action: Passed the Consent Agenda, with noted recusal.
3. City Council Budget Workshop Meeting Minutes
Action: Passed Motion 2024-082 approving the August 27, 2024 City Council Budget Workshop meeting minutes.
4. Amendment to Snow Removal Operations Agreement with Trella Tahoe, Inc.
Action: Passed Motion 2024-083 authorizing and directing the Mayor to execute a contract extension with Trella Tahoe, Inc. (C-230-2024) for snow removal services at the Airport, Fire Department, Police Department, Fire Rescue Facility, and sidewalks not maintained by City Park forces, plus on-call service as needed for a term of November 1, 2024 to April 30, 2025 in an amount not to exceed $397,722.00.
5. Amendment of Custodial Services Agreement with Building Services of CA and NV, LLC, for Bellamy Garage and City Hall/Airport Terminal
Action: Passed Motion 2024-084 authorizing and directing the Mayor to execute the Amendment to Custodial Services Agreement with Building Services of CA and NV, LLC (dba Sunwest) (C-231-2024), to extend the Agreement for one year for an amount not to exceed $107,168.00, which includes a $5,000.00 contingency.
6. Side Letter to South Lake Tahoe Police Officers' Association Memorandum of Understanding Regarding Sick Leave
Action: Passed Resolution 2024-092 approving a Side Letter with the Police Officers' Association (SLTPOA) (C-232-2024) to increase sick leave accrual limits to one-thousand (1000) hours and allow conversion of sick leave upon retirement to CalPERS service credit. 09 10 2024 CC Minutes
31 7. Acceptance of FAA Grant and Award of Contract for Airport Pavement Maintenance to Q & D Construction, LLC
Action: Passed Resolution-093 authorizing the Airport Manager to accept FAA Grants, appropriating Airport Enterprise Funds in the amount not to exceed $426,400.00 for airport pavement maintenance; and (2) Pass a Motion authorizing and directing the Mayor to execute an agreement with Q & D Construction, LLC (C-046-2024) for Airport Pavement Rehab for $856,300.00, plus a 5% Contingency, in the amount of $42,900.00, with total not-to-exceed amount of $899,200.00.
8. Amendment No. 9 to Professional Services Agreement with Stantec Consulting Services, Inc.
Action: Passed Motion 2024-086 authorizing and directing the Mayor to execute Amendment No. 9 to the Agreement with Stantec Consulting Services, Inc. (C-233-2024) for additional bidding and construction support services for the Tahoe Valley Stormwater and Greenbelt Improvement Project for the amount of $20,000.00 for a total not-to-exceed contract amount of $779,100.00.
9. Tahoe Regional Planning Agency (TRPA) Water Quality Mitigation Funding and Supplemental Environmental Project (SEP) Funding for the Tahoe Valley Stormwater and Greenbelt Improvement Project
Action: Passed Resolution 2024-094 authorizing and directing the Director of Finance to appropriate the TRPA Mitigation Funding and SEP Funding to the Tahoe Valley Stormwater and Greenbelt Improvement Project, authorizing and directing the Mayor to execute the Agreement Related to Barton Basin SEP (C-234-2024), and authorizing and directing the City Manager to take any further actions necessary for completion of the SEP funding acceptance.
10. Tahoe Regional Planning Agency Stream Environment Zone (SEZ) and Water Quality Mitigation Funding for the Upper Bijou Park Creek Restoration Project Note: Councilmember Robbins recused himself from voting on this item due to real property interest in the area.
Action: Passed Resolution 2024-095 authorizing and directing the Director of Finance to appropriate $400,000 in TRPA Mitigation Funding to the Upper Bijou Park Creek Restoration Project.
Written Public Comment was received from the following people:
1. Rachel Carson
2. Saundra Edwards
3. John Powell
4. Vasily Sleptsov
11. Community Development Block Grant Program Coronavirus Response Allocation of Remaining Funding for Tahoe Coalition for the Homeless Bears Den Inn Rehabilitation Action: Passed Resolution 2024-096 authorizing an amendment to the Standard Agreement issued under the 2020 Community Development Block Grant Program Coronavirus Response (CDBG-CV) for allocation of remaining funding for Tahoe Coalition for the Homeless Bears Den Inn Rehabilitation.
09 10 2024 CC Minutes
32 12. Addendum and Amendment #3 to the Subrecipient Agreement with Tahoe Coalition for the Homeless for 2020 Community Development Block Grant Program - Coronavirus Response Round 2 & 3
Action: Passed Motion 2024-087 approving the Duplication of Benefits Policy as an addendum to the Subrecipient Agreement between City of South Lake Tahoe and Tahoe Coalition for the Homeless for 2020 Community Development Block Grant Program - Coronavirus Response Round 2 & 3. It is also recommended that the City Council adopt an amendment (Amendment #3) to the Subrecipient Agreement (C-235-2024) extending the timeframe from October 28, 2023 to March 31, 2026.
13. Restricted Grant Agreements with the California Department of Transportation Accepting up to $420,517 the South Lake Tahoe Multimodal Mainstreet Corridor Plan Action: Passed Resolution 2024-097 authorizing the Public Works Director, or designee, to execute all Restricted Grant Agreements (C-236-2024) and any amendment thereto with the California Department of Transportation for the South Lake Tahoe Multimodal Mainstreet Corridor Plan, and amending Fiscal Year 2023/2024 budget to appropriate grant funds and matching funds totaling $475,000 to the project account.
Public Comment was heard from the following person:
1. Ed Mosur
14. Fiscal Year 2024-2025 Investment Policy and Authority Action: Passed Resolution 2024-098 delegating investment authority to the City Treasurer and adopting the City Investment Policy for the fiscal year from October 1, 2024 to September 30, 2025.
15. Permanent Local Housing Allocation (PLHA) Grant Amendment Action: Passed Resolution 2024-099 authorizing an amendment to the PLHA application that was initially authorized by Resolution 2020-060 and amended in Resolution 2023-095 to be utilized for the Preapproved Accessory Dwelling Unit plans.
16. Conflict of Interest Code Update
Action: Passed Resolution 2024-100 approving updates to the City’s Conflict of Interst Code.
17. League of California Cities Annual Conference Voting Delegate and Alternate Action: Passed Motion 2024-088 selecting Councilmember Robbins as Voting Delegate and Heather Stroud, City Attorney, as Alternate Voting Delegate at the League Annual Conference (Long Beach, October 16-18)
Public Comment wa heard from the following people:
1. Scott Loberg
2. Ed Mosur
09 10 2024 CC Minutes
33 Regular- Unfinished Business
18. Amendment No. 2 to the Funding Agreement with the South Shore Transportation Management Association to Extend Term for One Year at a total Cost of $650,000 Action: Moved/Seconded: Wallace/Creegan
Yes: Bass, Creegan, Wallace, Robbins
Action: 1) Passed Motion 2024-089 authorizing and directing the Mayor to execute Amendment No. 2 to the Funding Agreement with the South Shore Transportation Management Association (SS/TMA) to extend the term for one year (C-237-2024); and, 2) Passed Resolution 2024-101 appropriating $500,000 from General Fund Undesignated Excess Reserves in fiscal year 24/25 to fund microtransit services through September 30, 2025.
Public Comment was heard from the following people:
1. Scott Loberg
2. Chris Proctor, Chair of SS/TMA
3. Ed Mosur
19. Mid-Town Area Plan: Priority Topics and Stakeholder Engagement Update Note: Mayor Bass recused himself from voting on this item due to real property interest in the area, and left the meeting. Councilmebmer Wallace presided.
Action: Moved/Seconded: Creegan/Robbins
Yes: Wallace, Creegan, Robbins
Recused: Bass
Action: Passed Motion 2024-090 confirming priority topics to be addressed in the Mid-Town Area Plan as: (1) implementation of redevelopment strategies and incentives; (2) creation of arts district; (3) transportation improvements; (4) encouraging housing development; (5) concentration of City services and civic amenities; and (6) enhancement of recreation assets.
Public Comment was heard from the following people:
1. Steve Teshara, Tahoe Chamber
2. Gary and Karen Woldesen
Note: At this time, Mayor Bass returned to the meeting and presided.
Regular- New Business
20. Presentation by California Department of Transportation on Hot Mix Asphalt Concrete and Portland Cement Contract for Roadway Rehabilitation on State Highways Note: An updated Powerpoint presentation was submitted after agenda publication.
Action: Received and filed.
The following person addressed Council:
1. Menjot Gill, Caltrans
Public Comment was heard from the following people:
1. Karen Woldesen
2. Scott Loberg
3. Ed Mosur
Note: Mayor Bass requested staff bring back a discussion item on a request for proposal to hire a consultant to analyze the feasibility of geothermal use (Wallace seconded). 09 10 2024 CC Minutes
34 21. Annual Report on Homelessness
Note: a Powerpoint presentation was submitted after agenda publication.
Action: Received and filed.
Public Comment was heard from the following people:
1. Chelsea Thomas, Live Violence Free
2. Chris Proctor, Barton Health
22. Patagonia Product Procurement
Action: Moved/Seconded: Creegan/Wallace
Yes: Bass, Creegan, Wallace, Robbins
Action: Passed Motion 2024-092 directing the City Manager or designee to open a B2B group discount account with Patagonia in compliance with the City's procurement policy.
23. Update on City Website Improvements
Action: Received and filed.
Public Comment was heard from the following person:
1. Scott Loberg
24. Airport Food & Beverage Lease & Concession Agreement with Flight Deck Grill & Golf Club, LLC
Action: Moved/Seconded: Robbins/Creegan
Yes: Bass, Creegan, Wallace, Robbins
Action: Passed Motion 2024-092 authorizing and directing the Mayor to execute the Airport Food & Beverage Lease & Concession Agreement with Flight Deck Grill & Golf Club, LLC (C-238-2024).
Public Comment was heard from the following people:
1. Scott Loberg
25. Extension to Agreement with Axon for Body Worn Camera and In Car Video Systems Action: Moved/Seconded: Wallace/Creegan
Yes: Bass, Creegan, Wallace, Robbins
Action: Passed Resolution 2024-102 authorizing and directing the Mayor to execute a five year contract extension with Axon for Body Worn Camera - In Car Video systems (C-239-2024) with unlimited data storage, enhanced support software, licenses, and a no questions warranty for $980,976.45, payable over five years of the contract, interest free, and appropriating $195,986 from General Fund Undesignated Excess Reserves into FY 2024/2025 budget for the first annual payment.
Agenda Planning Calendar
26. Agenda Planning Calendar
Action: Received and filed.
Updates and Announcements (City Attorney, City Clerk, City Manager) City Manager Irvin
1. Upcoming State of the College Address
2. Upcoming Multicultural Festival
09 10 2024 CC Minutes
35 City Clerk Blankenship
1. Showed John Messina’s public comment video
2. Proclamation request for Domestic Violence Awareness Month (Council provided consensus)
3. Soliciting applications for City Council vacancy
Councilmember Reports and Comments
Councilmember Wallace
1. Attended 40th Anniversary event for the California Tahoe Conservancy
2. Attended Ski Run Park opening ceremony
Councilmember Robbins
1. Attended Tahoe Regional Planning Agency Housing Forum
2. Attended Ski Run Park opening ceremony
3. Requested an item to consider alternative bike routes and bike parking that limit cars in these spaces (Bass seconded)
4. Conversations with City staff about the creation of parklets using city-owned land.
Councilmember Creegan
1. Attended Ski Run Park opening ceremony
2. Requested item to explore contracts for service with local nonprofits (Bass seconded) Mayor Bass
1. Upcoming State of the City Address
Ajourment
Mayor Bass ajourned the Meeting at 1:16 p.m.
Date:_______________
______________________
Cody Bass, Mayor
Attest:__________________________
Susan Blankenship, City Clerk
The presence of electronic signature certifies that the foregoing is a true and correct copy as approved by the South Lake Tahoe City Council.
09 10 2024 CC Minutes
36 City of South Lake Tahoe
Special City Council - State of the City Address
Meeting Minutes
Tuesday, September 17, 2024 at 5:30 pm
Beach Retreat & Lodge
3411 Lake Tahoe Boulevard, South Lake Tahoe, CA 9615
NOTE: The Meeting Minutes represent actions taken during this special meeting of the City Council. Complete Council member actions during the meeting can be viewed in archived video recordings on the City’s website at http://www.cityofslt.us. Public submittals on items are retained in the administrative record and can be viewed in the City Clerk’s repository at http://www.cityofslt.us Tribal Land Acknowledgement
Mayor Bass read the Washoe Tribe of Nevada and California Land Acknowledgement.
Call to Order/Pledge of Allegiance
Mayor Bass called the meeting to order at 5:57 p.m., then led the pledge of allegiance.
State of the City Adress by Mayor Bass
Action: Received and Filed.
Public Comment
None.
Ajournment
Mayor Bass Ajourned the meeting at 6:39 p.m.
______________________ Date:________________________
Cody Bass, Mayor
Attest:__________________________
Susan Blankenship, City Clerk
The presence of electronic signature certifies that the foregoing is a true and correct copy as approved by the South Lake Tahoe City Council.
09 17 2024 Special CC Minutes
37 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:4
Agenda Item: Fiscal Year 2023-24 Quarterly Financial Status Report - Quarter Ending June 2024 Executive Summary: In accordance with the City's Financial Policies, the Finance Department submits reports to City Council on a periodic basis to provide assurance of budget compliance and for informational and comparative purposes. Attachment 2, “FY 2023/24 Quarterly Budget and Financial Status Report for Period Ending June 30, 2024†summarizes operating revenues and operating expenditures (unaudited figures) for the General Fund and Measure S Sales Tax Fund for the year-todate providing an analysis of any significant budget variances.
Requested Action / Suggested Motions: Receive and file.
Responsible Staff Member: Andrew Black, Financial Services Supervisor Reviewed and Approved By: Susan Blankenship, City Clerk Olga Tikhomirova, Director of Finance Heather Stroud, City Attorney
Attachments:
01-Staff Report-Fiscal Year 2023 24 Quarter End Financial Status Report as of June 2024.docx 02-FY 2023-24 Qtrly Budget Report June 2024.pdf
38 Council Agenda Report- September 24, 2024 Page 1 of 2 City of South Lake Tahoe
Report to City Council
Meeting Date: September 24, 2024
Title: Fiscal Year 2023/24 Quarter End Financial Status Report as of June 2024 Location: Citywide
Responsible Staff Member: Olga Tikhomirova, Director of Finance, Andrew Black, Financial Services Supervisor
Background: The Finance Department submits quarterly reports to City Council to provide assurance of budget compliance and for informational and comparative purposes throughout the year. Attachment 2, “FY 2023/24 Quarterly Budget and Financial Status Report for Period Ending June 30, 2024” is an unaudited snapshot of year-to-date actual revenues and expenditures for the General Fund for that period.
Issue and Discussion: At the end of June 2024 with 75% of the year complete, primary General Fund actual revenues were at 67.7% of the amended budget, while expenditures were at 60.2% of appropriations. All departmental expenditures were below the total 75.0% threshold allocated to the first three quarters of the fiscal year.
Measure S Sales Tax revenue, accounted for in a separate general fund, amounted to approximately 55.4% of the adopted budget, while the scheduled transfers used up 81.6% of the total expenditures budget. See Attachment 2 for further analysis.
Financial Implications: As of June 30, 2024, or after the first nine months of the fiscal year, actual General Fund revenues exceeded expenditures by $739K. This net revenue is primarily attributed to strong performance in Property Tax and Motor Vehicle License Fees (MVLF), where the full annual budgeted revenue allocation has been met, and the revenue collection has exceeded budgetary expectations. These two revenues combined constitute approximately 23% of the total budget and approximately 35% of the actuals for the General Fund through June 30.
Compared to the same period last year, overall revenues have increased by approximately
4.8%, or $1.9M. This increase is attributed to positive performance in several revenue categories, including Property Tax and MVLF (each increased by approximately 8%, or $1.0M combined), and interest revenue (up 41% or approximately $700K). These increases were offset by decreases in the City’s two major revenue sources. Transient Occupancy Tax (including TOT from the Project area) was down 5.6% or $540K, while Sales Tax and Measure Q combined were down $73K or 1.3% through June 30. Expenditures increased 19.2%, or $6.4 million compared to the same period last fiscal year largely due to the timing of one-time transfers-out for various capital expenditures and programs in addition to citywide increases in personnel costs.
Environmental Considerations: This is not a “project” subject to review under the California Environmental Quality Act (CEQA) Guidelines section 15378(b)(5) (organizational or 39 Council Agenda Report- September 24, 2024 Page 2 of 2 administrative activities that will not result in direct or indirect physical changes in the environment).
Policy Implications: Consistent with City’s Financial Policies. 40 2023-24 QUARTERLY FINANCIAL REPORT Page 1 of 2 3rd QUARTER ENDING June 30, 2024
CITY OF SOUTH LAKE TAHOE
2023-24 QUARTERLY FINANCIAL REPORT
3 RD QUARTER ENDING JUNE 30, 2024
This report summarizes the City’s financial position for the General Fund for Fiscal Year 2023-24 displaying expenditures at the department level and revenues by type. It compares actual revenues and expenditures received through June 2024 to the total budget and analyzes major variances to the previous fiscal year’s actuals.
General Fund Financial Condition
As of June 30th, with 75% of the year complete, General Fund revenues are at 67.7% of projections and expenditures are at 60.2% of appropriations.
Revenues. The top three revenues, Property Tax, City Transient Occupancy Tax (TOT), and Sales Tax generated 54.2% of the total $40.4 million General Fund revenues collected through June 30.
Property Tax and Motor Vehicle License Fees
(MVLF) received through June 30, 2024,
reflect two major installments for the current
year. Their positive performance compared to
the same period last year (with an increase of
7.6% and 8.1% respectively), has resulted in
these revenues exceeding their annual budget
allocations.
TOT receipts, including TOT from the Project
area but excluding TOT audits, showed a
decrease of $540K, or 5.6%, while Sales Tax
and Measure Q revenue combined was 1.3%
or $73K lower than the same period last fiscal
year.
Several revenue categories boosted revenue
collection through the end of third quarter.
Finance Other Revenue increased $696K
primarily driven by an increase in interest
revenue while Franchise Fees increased by $169K due to a new agreement with South Tahoe Refuse Company. Other departmental revenues increased because of higher transfers from other funds in addition to positive performance in various other revenue sources such as Parking & Citation fines, Parks & Recreation fees (including Golf Course and Boat Ramp), and insurance reimbursements. Fire
revenue, which is currently at 14.7% of total
budget to date, will increase substantially at
year-end due to an outstanding transfer-in
from Measure S Sales Tax fund for seven
firefighters. Overall revenues were $1.9M
higher than the same period last year.
Expenditures. Out of the actual expenditures
totaling $39.7 million through June 30th
,
approximately $22.6 million or 56.8% was
Expenditures by Department
Total Budget
as of
June 30
Actuals
through
June 30
As % of
Budget
General Government 6,003,277$ 2,531,205$ 42.2%
Finance 3,234,034 2,365,611 73.1%
Miscellaneous General Fund 18,069,742 11,798,945 65.3%
Police 15,209,613 8,741,874 57.5%
Fire 11,488,217 6,651,570 57.9%
Public Works 5,386,706 3,568,831 66.3%
Development Services 2,216,447 1,349,117 60.9%
Parks and Recreation 4,280,340 2,686,913 62.8%
EXPENDITURES TOTAL 65,888,376$ 39,694,066$ 60.2%
Revenues by Type
Total Budget
as of
June 30
Actuals
through
June 30
As % of
Budget
Property Tax 10,850,000$ 11,099,447$ 102.3%
Transient Occupancy Tax - City 10,822,562 5,061,879 46.8% Transient Occupancy Tax - Project Area 7,600,000 4,013,092 52.8% Sales Tax 7,264,000 3,677,863 50.6%
Measure Q 3,800,000 2,082,655 54.8%
Motor Vehicle License Fees (MVLF) 2,772,000 2,969,117 107.1% Franchise Fees 1,900,000 1,421,551 74.8%
Business License Tax 1,935,000 1,276,467 66.0%
Finance - Other Revenues 2,260,355 2,405,035 106.4%
General Government 242,563 28,688 11.8%
Police 2,794,318 2,063,845 73.9%
Fire 3,184,468 466,663 14.7%
Public Works 639,300 739,939 115.7%
Development Services 2,507,382 2,323,814 92.7%
Parks and Recreation 1,060,829 651,933 61.5%
Transfers In 104,200 74,200 71.2%
Miscellaneous General Fund 30,000 76,893 256.3%
REVENUES TOTAL 59,766,977$ 40,433,081$ 67.7%
41 2023-24 QUARTERLY FINANCIAL REPORT Page 2 of 2 3rd QUARTER ENDING June 30, 2024 allocated to personnel expenses, covering 19 payroll periods, which represents 73.1% of the total payroll periods for the year. Out of the remaining 43.2% or approximately $17.1 million of actual expenditures, $9.9 million is attributed to transfers-out, $2.6 million to professional, technical, and other contract services, $1.9 million to miscellaneous general expense including taxes and fees, travel and training, communications etc., $1.1 million to purchases of tools, parts, software, machinery and equipment, and the remaining $1.6 million to utilities, general supplies, and other miscellaneous expense.
Overall expenditures exceeded the same period last fiscal year by 19.2%, or $6.4 million. Personnel costs account for a large portion of this increase. This category was 14.6% or $2.9 million higher than the same period last year, primarily due to implementation of new Memoranda of Understanding for the City’s six bargaining units and the Compensation and Benefits package for the City’s unrepresented employees, effective October 1st, 2023. A lower number of vacancies in the current fiscal year also contributed to the personnel cost increase compared to the same period last fiscal year.
Transfers-out, accounted for within the Miscellaneous General Fund Category, increased approximately $2.9 million primarily due to timing of one-time transfers for various capital expenditures and projects. Other increases in overall expenditures compared to prior year can be attributed to software implementation costs, machinery/equipment purchases, technical/professional services, and increased cost of utilities and supplies. The annual payment of the CalPERS Unfunded Accrued Liability (UAL) was made in July 2024 ($7.1 million General Fund portion) and will impact the percentage of actual expenditures to total budget in the final quarter of FY 2023-24. All departments have maintained expenditures below the 75% threshold allocated to the first three quarters of the fiscal year.
Measure S Sales Tax General Fund
Measure S, a 1% city-wide sales and use tax, went into effect on April 1, 2021 and is projected to generate $7.6 million for fiscal year 2023/24.
Revenues. The City received Measure S Sales
Tax totaling approximately $4.2 million as of
June 30th, 2024.
Expenditures. During the adoption of the FY
2023/24 budget, City Council allocated
approximately $6.3M of the total projected
annual revenue to various Capital Improvement
Projects, Safety personnel funding, Debt Service
payments, and funding for other programs such
as Fuels Reduction and Stormwater.
Throughout the fiscal year, additional
appropriations of Measure S revenue were
made for high priority projects such as Fire
Station III Interim Upgrades, Sidewalk Snow
Removal, Vehicle/Equipment Replacement
including two graders and a brine tank, and
additional funding for road reconstruction. As a
result of these additional appropriations,
budgeted expenditures for Measure S Sales Tax
totaled $9.2 million.
As of June 30th, 2024 approximately $7.5 million
has been transferred out for these Measure S funded projects and programs.
Measure S Sales Tax Total Budget as
of June 30
Actuals through
June 30
As % of
Budget
REVENUES
Measure S Sales Tax 7,600,000$ 4,162,927$ 54.8%
Interest/Dividends Revenue - 46,023 100.0%
Transfer In 9,506 9,506 100.0%
REVENUES TOTAL 7,609,506$ 4,218,456$ 55.4%
EXPENDITURES and FINANCING USES
Technical Services 10,000 6,413 64.1%
Transfer out to/for:
Debt Service - Communication System 554,643 554,643 100.0% Debt Service - Snow Removal Equip 602,721 602,721 100.0% Fire Marshall position (50%) 120,107 - 0.0%
Fire Station III Set-Aside 500,000 500,000 100.0%
Fire Station III Interim Upgrades 300,000 300,000 100.0% Pioneer Trail Ph. 2 300,000 300,000 100.0%
Police Lieutenant position 320,000 - 0.0%
Road Reconstruction 3,080,000 3,080,000 100.0%
Seven (7) Firefighters 1,326,619 210,915 15.9%
Sidewalk Snow Removal 126,000 126,000 100.0%
Snow Removal Equipment 1,197,000 1,197,000 100.0%
South Shore Fuels Reduction Program 127,000 - 0.0%
Storm Water Program 136,054 136,054 100.0%
Vehicle Replacement 481,379 481,379 100.0%
EXPENDITURES TOTAL 9,181,523$ 7,495,125$ 81.6%
42 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:5
Agenda Item: Temporary Overlap of Police Officer Position Executive Summary: Sgt. Molesworth is retiring 01/17/2025. A Police Officer will be promoted to Sergeant, which will create a Police Officer vacancy. We have two (2) spots reserved in Sacramento PD's police academy which starts 01/06/2025. There is a current eligible hiring list of local candidates for Police Trainee. One (1) candidate is in background investigation for a current vacancy. If authorized, overlapping the Police Officer vacancy created by Sgt. Molesworth's retirement by 4 weeks allows time for a Police Officer background investigation, City onboarding, PD orientation, and reduced time delay in vacant positions. The overlapped position will fill the second Sacramento PD academy spot, starting on 01/06/2025.
Requested Action / Suggested Motions: Pass a Resolution authorizing an amendment to the FY 24/25 List of Allocated Permanent Positions increasing Police Officers (excluding cannabis program) from 31 FTE to 31.1 FTEs for a four (4) week overlap of the position in fiscal year 24/25.
Responsible Staff Member: Lt. Scott Crivelli
Reviewed and Approved By: Susan Blankenship, City Clerk Olga Tikhomirova, Director of Finance Heather Stroud, City Attorney
Attachments:
01-Staff Report - Temporary Overlap of Police Officer Position.docx 02-Resolution - Temporary Overlap of Police Officer Position.docx 03-Position Allocation 24-25 Budget Sep 2024 (Exh. 1 to Reso).pdf 43 Council Agenda Report September 24, 2024 Page 2 of 2 City of South Lake
Tahoe
Report to City Council
Meeting Date: September 24, 2024
Title: Temporary Overlap of Police Officer Position
Location: Citywide
Responsible Staff Member: Lt. Scott Crivelli
Background: The South Lake Tahoe Police Department is allocated 42 FTE Sworn Peace Officer positions, 32 of which are Police Officers (including cannabis program). Sgt Molesworth is retiring from SLT PD on January 17, 2025, after 24 years of service to the City of South Lake Tahoe.
Sgt Molesworth’s retirement in January will result in a current Police Officer being promoted to Sergeant, which will create a Police Officer vacancy. Currently, there is an eligible hire list for Police Trainee. Sacramento Police Academy has two (2) spots reserved for SLT PD, for their academy starting January 6, 2025.
Issue and Discussion: Today’s job market for Police Officer’s is extremely competitive. Qualified local candidates are currently active on an eligible hire list. All candidates on the eligible hiring list are current local residents looking to enter the City’s career pipeline. Not advancing qualified candidates through the process quickly could result in them testing and being hired elsewhere.
Additionally, spots in the Sacramento police academies are very difficult to obtain due to all northern California agencies attempting to get candidates through the same academies. Agencies are often waitlisted for academy spots.
The reserved spots in the academy starting January 2025 will be filled by a candidate currently in backgrounds for a current vacant officer position and if approved by council, a second candidate who will fill Sgt Molesworth’s vacancy resulting from his retirement. The overlap is needed to allow appropriate time for a Police Officer background investigation, which can take several weeks to months. Also, the employee would need to be hired 2 weeks prior to the academy start date in order to complete City on boarding and a Police Department orientation period.
This item is before the City Council for authorization and approval of the included amended Allocated Position Listing (Exh.1). The Allocated Position Listing has been amended from 31 FTE Police Officers (non-cannabis) to 31.1 (1/12 of the year). The temporary overlap is for a time period of 4 weeks (2 pay periods). 12/21/24-01/17/25. These dates reflect the date a Police Trainee would be hired, and the date Sgt Molesworth retires.
Financial Implications: The cost for the overlap of the Police Officer position at a Police Trainee level for a period of 4 weeks is $10,189.
44 Council Agenda Report September 24, 2024 Page 2 of 2 The additional budget will be requested at mid-year if needed, after evaluation of potential salary savings from vacancies.
Environmental Considerations: The proposed action is not a “project” subject to review under the California Environmental Quality Act (CEQA) under CEQA Guidelines section 15378(b)(4) (creation of government funding mechanisms or government fiscal activities which do not involve any commitment to any specific project which may result in a potentially significant physical impact on the environment).
Policy Implications: This resolution supports the following strategic priorities:
4.3 (2) – Evaluate and Develop career pipelines to the City with incentives for hiring local in the City’s hiring practices.
5.1 – Public Safety
45 Resolution 2024-XXX September 24, 2024 Page 1 of 2
Resolution 2024-XXX
Adopted by the City of South Lake Tahoe
City Council
September 24, 2024
Authorizing the Overlap of a Police Officer Position
BACKGROUND
A. The Police Department is allocated 42 FTE Sworn Peace Officer positions, 32 of which are Police Officers (including cannabis program).
B. Sgt Molesworth is retiring from SLT PD on 1/17/2025. A Police Officer will be promoted to Sergeant, creating a Police Officer vacancy.
C. There is current Police Trainee eligibility list with local qualified candidates. SLT PD has spots reserved in the Sacramento Police Academy which starts 01/06/2025.
D. The 4 week overlap of this position will allow local candidates to be hired by the City by providing time for a Police Officer background and ensure readiness for the academy. Also, the overlap will help avoid unnecessary time delay filling a vacant Police Officer position.
BASED ON THE FACTS SET FORTH IN THE BACKGROUND, BE IT RESOLVED, that the City Council of the City of South Lake Tahoe:
1. Resolves that the above recitals are true and a substantive part of this resolution.
2. Authorizes amendment to the FY 24/25 List of Allocated Permanent Positions increasing Police Officers (non-cannabis) from 31 FTE to 31.1 FTEs for a four (4) week overlap of the position in fiscal year 24/25 (attached hereto as Exh. 1).
Adopted by the City of South Lake Tahoe City Council on September 24, 2024 by the following vote:
Yes:
No:
Absent:
Abstain:
________________________ Date:_________
46 Resolution 2024-XXX September 24, 2024 Page 2 of 2
Cody Bass, Mayor
Attest:
________________________
Susan Blankenship, City Clerk
The presence of electronic signature certifies that the foregoing is a true and correct copy as approved by the South Lake Tahoe City Council.
47 Allocated Permanent Positions
Authorized/ Authorized/ Authorized/ Authorized/ Authorized/ Appropriated Appropriated Appropriated Appropriated Frozen Positions Positions Positions Positions Positions
Department/Positions 23/24 Adopted thru May'24 24/25 Adopted thru Oct'24 24/25 Budget
CITY COUNCIL
Council Member (Elected) Department Total 5.00 5.00 5.00 5.00 0.00
CITY CLERK
City Clerk (Elected) 1.00 1.00 1.00 1.00
Assistant City Clerk 1.17 1.17 1.00 1.00
Department Total 2.17 2.17 2.00 2.00 0.00
CITY TREASURER
City Treasurer (Elected) Department Total 1.00 1.00 1.00 1.00 0.00
CITY MANAGER DEPARTMENT
City Manager 1.00 1.00 1.00 1.00
Assistant City Manager 1.00 1.00 1.00 1.00
Assistant to the City Manager I 0.00 0.00 0.00 0.00
Assistant to the City Manager II 0.00 0.00 0.00 0.00
Communications and Project Specialist 1.00 1.00 1.00 1.00 Data and Innnovation Program Manager 0.00 0.00 1.00 1.00 Sustainability Coordinator 1.00 1.00 1.00 1.00
4.00 4.00 5.00 5.00
Human Resources
Human Resources Manager 1.00 1.00 1.00 1.00
Principal &/or H.R. Analyst 2.00 2.00 2.00 2.00
Total 3.00 3.00 3.00 3.00 0.00
Department Total 7.00 7.00 8.00 8.00 0.00
CITY ATTORNEY
City Attorney 1.00 1.00 1.00 1.00
Assistant City Attorney 1.00 1.00 1.00 1.00
Risk Manager 1.00 1.00 1.00 1.00
Paralegal 1.00 1.00 1.00 1.00
Department Total 4.00 4.00 4.00 4.00 0.00
FINANCE DEPARTMENT
Director of Finance 1.00 1.00 1.00 1.00
Total 1.00 1.00 1.00 1.00 0.00
Financial Services
Financial Services Supervisor 1.00 1.00 1.00 1.00
Accountant I, II 1.00 1.00 1.00 1.00
Accountant I / Payroll Coordinator 1.00 1.00 1.00 1.00
Principal Management Analyst - Purchasing and Grants 1.00 1.00 1.00 1.00 Total 4.00 4.00 4.00 4.00 0.00
Revenue
Accounting Technician I, II 2.00 2.00 2.00 2.00
Supervising Accounting Technician 1.00 1.00 0.00 0.00
Assistant Management Analyst 0.00 0.00 1.00 1.00
Accountant I/II 1.00 1.00 1.00 1.00
Total 4.00 4.00 4.00 4.00 0.00
Information Systems
Information Systems Supervisor 1.00 1.00 0.00 0.00
Information Systems Manager 0.00 0.00 1.00 1.00
Network Systems Administrator 1.00 1.00 1.00 1.00
Information Systems Technician 1.00 1.00 1.00 1.00
Total 3.00 3.00 3.00 3.00 0.00
Department Total 12.00 12.00 12.00 12.00 0.00
1 of 3
48 Allocated Permanent Positions
Authorized/ Authorized/ Authorized/ Authorized/ Authorized/ Appropriated Appropriated Appropriated Appropriated Frozen Positions Positions Positions Positions Positions
Department/Positions 23/24 Adopted thru May'24 24/25 Adopted thru Oct'24 24/25 Budget
DEVELOPMENT SERVICES DEPARTMENT
Director of Development Services 1.00 1.00 1.00 1.00
Administrative Clerk I, II 1.00 1.00 1.00 1.00
Total 2.00 2.00 2.00 2.00 0.00
Planning
Planning Manager/Environmental Planner 1.00 1.00 1.00 1.00 Associate Planner, Assistant Planner 2.00 2.00 2.00 2.00 Sr. Planner 1.00 1.00 1.00 1.00
Development Services Technician 0.00 0.00 0.00 0.00 1.00 Total 4.00 4.00 4.00 4.00 1.00
Housing
Housing Manager 1.00 1.00 1.00 1.00
Associate Planner, Assistant Planner- Housing 1.00 1.00 1.00 1.00 Associate Management Analyst 1.00 1.00 1.00 1.00
Program Coordinator 1.00 1.00 1.00 1.00
4.00 4.00 4.00 4.00 0.00
Building and Safety
Building Official 1.00 1.00 1.00 1.00
Pr Bldg & Sr Bldg Inspector, Bldg Inspector, Hsng Insp. 4.00 4.00 4.00 4.00 Sr. Permit Center Technician, Permit Center Technician 2.00 2.00 2.00 2.00 Total 7.00 7.00 7.00 7.00 0.00
Department Total 17.00 17.00 17.00 17.00 1.00
PUBLIC WORKS DEPARTMENT
Director of Public Works 1.00 1.00 1.00 1.00
Capital Program and Facilities Program Manager 1.00 1.00 1.00 1.00 Office Manager 1.00 1.00 1.00 1.00
Total 3.00 3.00 3.00 3.00 0.00
Engineering
Construction Engineer 0.00 0.00 0.00 0.00 1.00
Complete Streets Program Manager 1.00 1.00 1.00 1.00
GIS Analyst 1.00 1.00 0.00 0.00
Resident Engineer / Resident Inspector 1.00 1.00 0.00 0.00 Engineering Manager 0.33 0.67 0.00 0.00
Associate Civil Engineer, Assistant Engineer 2.50 0.00 0.00 0.00 Associate Civil Engineer, Associate Architect 0.00 2.50 4.00 4.00 Engineering Technician I, II 1.00 1.00 1.00 1.00
Total 6.83 7.17 6.00 6.00 1.00
Maintenance Operations / Snow Removal
Maintenance Manager 2.00 2.20 2.17 2.17
Lead Maintenance Technician 2.00 2.50 3.00 3.00
Maintenance Technician I, II, III, IV, V 16.00 15.50 15.00 15.00 Total 20.00 20.20 20.17 20.17 0.00
Fleet Maintenance
Maintenance Manager - Fleet 1.00 1.00 1.00 1.00
Equipment Mechanic I, II, III 6.00 6.00 6.00 6.00
Fleet Control Specialist 1.00 1.00 1.00 1.00
Total 8.00 8.00 8.00 8.00 0.00
Airport
Airport Manager 1.00 1.00 1.00 1.00
Airport Maintenance Supervisor 1.00 1.00 1.00 1.00
Administrative Assistant I, II 1.00 1.00 1.00 1.00
Maintenance Technician I, II, III, IV, V 1.00 1.00 1.00 1.00 Total 4.00 4.00 4.00 4.00 0.00
Department Total 41.83 42.37 41.17 41.17 1.00
2 of 3
49 Allocated Permanent Positions
Authorized/ Authorized/ Authorized/ Authorized/ Authorized/ Appropriated Appropriated Appropriated Appropriated Frozen Positions Positions Positions Positions Positions
Department/Positions 23/24 Adopted thru May'24 24/25 Adopted thru Oct'24 24/25 Budget
PARKS AND RECREATION DEPARTMENT
Director of Parks and Recreation 1.00 1.00 1.00 1.00
Total 1.00 1.00 1.00 1.00
Recreation
Administrative Assistant I, II 1.00 1.00 1.00 1.00
Recreation Manager 1.00 1.00 1.00 1.00
Maintenance Manager - Recreation 0.00 0.33 1.00 1.00
Events Coordinator 1.00 1.00 1.00 1.00
Recreation Program Coordinator 0.00 0.42 1.00 1.00
Head Pool Lifeguard 1.00 1.00 1.00 1.00
Total 4.00 4.75 6.00 6.00
Parks
Maintenance Manager - Parks 1.00 1.00 1.00 1.00
Lead Maintenance Technician 1.00 1.00 1.00 1.00
Maintenance Technicians I, II, III, IV,V 7.00 7.00 7.00 7.00 Total 9.00 9.00 9.00 9.00
Department Total 14.00 14.75 16.00 16.00 0.00
FIRE DEPARTMENT
Fire Chief 1.00 1.00 1.00 1.00
Fire Division Chief (Grant Funded) 0.00 0.50 1.00 1.00
Fire Marshall 1.00 1.00 1.00 1.00
Fire Battalion Chief 3.00 3.00 3.00 3.00
Fire Captain 9.00 9.00 9.00 9.00
Fire Engineer 9.00 9.00 9.00 9.00
Firefighter, Paramedic 9.00 9.00 9.00 9.00
Firefighter, Paramedic (Meas. S, prev. SAFER Grant) 7.00 7.00 7.00 7.00 Fire Safety Inspector I, II 1.00 1.00 1.00 1.00
Executive Assistant to the Fire Chief 1.00 1.00 1.00 1.00 Department Total 41.00 41.50 42.00 42.00 0.00
POLICE DEPARTMENT
Chief of Police 1.00 1.00 1.00 1.00
Police Lieutenant 3.00 3.00 3.00 3.00
Police Sergeant 6.00 6.00 6.00 6.00
Police Officer 31.00 31.00 31.00 31.10 1.00
Police Officer (cannabis) 1.00 1.00 1.00 1.00
Police Officer (Tobacco grant) 0.00 0.00 0.00 0.00
Public Safety Dispatch Supervisor 1.00 1.00 1.00 1.00
Police Records Supervisor 1.00 1.00 1.00 1.00
Community Service Officer Supervisor 1.00 1.00 1.00 1.00 Public Safety Dispatcher 9.00 9.00 9.00 9.00
Senior Police Records Tech, Police Record Tech 2.00 2.00 2.00 2.00 Administrative Assistant I 1.00 1.00 1.00 1.00
Senior Evidence/Prop Tech, Evidence/Prop Tech 2.00 2.00 2.00 2.00 Sr Community Svcs Officer, Community Svcs Officer 4.00 4.00 4.00 4.00 Parking Ambassador 4.00 4.00 4.00 4.00
Code Compliance Investigator 1.00 1.00 1.00 1.00
Administrative Assistant II 1.00 1.00 1.00 1.00
Department Total 69.00 69.00 69.00 69.10 1.00
Total City Employees 214.00 215.79 217.17 217.27 3.00
3 of 3
50 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:6
Agenda Item: Investment Portfolio Report - June 30, 2024 Executive Summary: In accordance with the City of South Lake Tahoe Financial Policies and State law, a quarterly investment report is hereby submitted to the members of the City Council. As of June 30, 2024, the City's total cash and investment balances across all funds is $174.0 million.
Requested Action / Suggested Motions: Receive and File.
Responsible Staff Member: Olga Tikhomirova, Director of Finance Reviewed and Approved By: Susan Blankenship, City Clerk Heather Stroud, City Attorney Attachments:
01-Staff Report Investment Report June 2024.docx
02-Operations Cash 06 30 2024.pdf
03-Fiscal Agent 06 30 2024.pdf
04-Graph 06 30 2024.pdf
05-Cash June 2024.pdf
51 Council Agenda Report September 24, 2024 Page | 1 of 1 City of South Lake Tahoe
Report to City Council
Meeting Date: September 24, 2024
Title: Investment Portfolio Report as of June 30, 2024
Location: Citywide
Responsible Staff Member: Olga Tikhomirova, Director of Finance (530) 542-7431 Background: In accordance with the City of South Lake Tahoe Financial Policies and State law a quarterly investment report shall be submitted to the members of the City Council.
Issue and Discussion: The attached report for the period ending June 30, 2024, describes the type of investments, the issuers, the maturity dates, the par value and the market value. Total cash for operations and cash held by fiscal agents is $174,042,512.
Cash available for operations is $110,639,921. This includes Cash in Bank of $7,916,439 with the remaining amount in various investments diversified in accordance with the City’s adopted Investment Policy. The total portfolio yield is 4.76%. Based on this report the City of South Lake Tahoe will be able to meet projected operating expenditures for the next six months.
Cash held by fiscal agents for debt service is $63,402,591. These investments comprise the reserves and other accounts held in trust for debt service, lease financing, and capital projects financed with debt.
Fund Type Total Cash Balance Operations Balance Fiscal Agent Balance Trust and Agency $13,588,631 $7,655,973 $5,932,658
Special Revenue $33,420,572 $33,420,572 -
General Fund $32,768,282 $32,768,282 -
Internal Service $8,072,249 $8,072,249 -
Debt Service $58,803,249 $1,350,595 $57,452,654
Enterprise $4,192,067 $4,174,788 $17,279
CIP $23,197,462 $23,197,462 -
Grand Total $174,042,512 $110,639,921 $63,402,591
The attached documents include investment terms that are defined below:
Current yield – The investments annual income (interest or dividends) divided by the current price of the security.
Weighted par – Weighting the price of each bond by the total price of the entire portfolio. Weighted yield – The current yield multiplied by the weighted par, provides the yield of the bonds in the portfolio.
Financial Implications: None.
Environmental Considerations: This is not a “project” subject to review under the California Environmental Quality Act (CEQA) Guidelines section 15378(b)(2) (continuing administrative or maintenance activities, such as purchases for supplies)
Policy Implications: Consistent with City’s Financial Policies. 52 CITY OF SOUTH LAKE TAHOE
OPERATIONS CASH INVESTMENT PORTFOLIO REPORT
AS OF JUNE 30, 2024
INVESTMENT TYPE ISSUER PAR VALUE
Local Agency Investment Fund State Treasurer 55,966,732$ 55,760,553$ 4.480% 50.6% 2.27% N/AFederal Home Loan Bank Government Agency 1,000,000$ 930,273$ 1.000% 0.90% 0.01% 5/27/2026Federal Farm Credit Banks Government Agency 1,000,000 $ 923,496$ 1.500% 0.90% 0.01% 12/14/2026Fed. Home Loan Bank Government Agency 1,000,000$ 957,958$ 3.000% 0.90% 0.03% 3/29/2027Federal Farm Credit Banks Government Agency 1,000,000 $ 968,870$ 3.110% 0.90% 0.03% 4/13/2026Federal Farm Credit Banks Government Agency 2,000,000 $ 2,000,915$ 5.520% 0.90% 0.10% 5/29/2029 Fed. National Mtg Association Government Agency 2,000,000$ 1,996,845$ 5.300% 1.81% 0.10% 6/30/2027 Fed. Home Loan Bank Government Agency 1,000,000$ 991,283$ 4.250% 0.90% 0.04% 6/20/2025Fed. Home Loan Bank Government Agency 1,000,000$ 978,293$ 4.100% 0.90% 0.04% 6/30/2027Fed. Home Loan Bank Government Agency 1,000,000$ 995,851$ 5.000% 0.90% 0.05% 9/30/2027Fed. Home Ln Mtg Corp Government Agency 1,000,000$ 998,248$ 5.050% 0.90% 0.05% 12/19/2024 Fed. Home Ln Mtg Corp Government Agency 1,000,000$ 997,205$ 5.300% 0.90% 0.05% 11/28/2025 S
Fed. Home Loan Bank Government Agency 2,500,000$ 2,496,132$ 5.140% 2.26% 0.12% 12/18/2025Fed. Home Ln Mtg Corp Government Agency 2,000,000$ 1,998,025$ 5.000% 1.81% 0.09% 8/22/2024 Fed. Home Loan Bank Government Agency 1,000,000$ 986,434$ 4.550% 0.90% 0.04% 1/16/2029Fed. National Mtg Association Government Agency 2,000,000$ 1,990,449$ 5.170% 1.81% 0.09% 1/29/2029 Fed. National Mtg Association Government Agency 2,000,000$ 2,005,011$ 5.625% 1.81% 0.10% 4/16/2029Fed. Home Loan Bank Government Agency 3,000,000$ 2,991,528$ 5.060% 2.71% 0.14% 2/13/2026Fed. Home Loan Bank Government Agency 3,000,000$ 3,013,322$ 5.000% 2.71% 0.14% 2/20/2029Fed. Home Loan Bank Government Agency 5,000,000$ 4,972,607$ 5.220% 4.52% 0.24% 12/11/2026Fed. Home Loan Bank Government Agency 2,500,000$ 2,497,825$ 5.700% 3.16% 0.13% 5/1/2029Fed. National Mtg Association Government Agency 4,000,000$ 3,968,709$ 5.030% 3.62% 0.18% 12/18/2026 Fed. Home Ln Mtg Corp Government Agency 3,500,000$ 3,496,049$ 5.400% 3.16% 0.17% 12/21/2026
WEIGHTED
PAR
WEIGHTED
MARKET VALUE CURRENT YIELD YIELD MATURITY DATE
1 of 2
53 CITY OF SOUTH LAKE TAHOE
OPERATIONS CASH INVESTMENT PORTFOLIO REPORT
AS OF JUNE 30, 2024
Fed. National Mtg Association Government Agency 1,000,000$ 998,036$ 5.300% 0.90% 0.05% 3/5/2027 Certificate of Deposit Morgan Stanley Private Bk Natl 250,000$ 250,224$ 5.200% 0.23% 0.01% 12/5/2025Certificate of Deposit Morgan Stanley Bk N A 250,000$ 250,224$ 5.200% 0.23% 0.01% 12/5/2025Certificate of Deposit Capital One NA 250,000$ 245,039$ 3.100% 0.23% 0.01% 6/2/2025Certificate of Deposit Capital One Bank (USA) NA 250,000$ 241,769$ 3.150% 0.23% 0.01% 6/2/2026Certificate of Deposit State Bank of India 250,000$ 239,410$ 3.300% 0.23% 0.01% 6/1/2027 Bank of America Corp Corporate Note 1,000,000$ 991,258$ 5.650% 0.90% 0.05% 3/8/2029Cash in Bank General & Sweep 7,916,439$ 7,916,439$ 0% - 5.18455% 7.16% 0.43% N/APetty Cash 6,750$ 6,750$ N/A 0.01% 0.00% N/A TOTAL 110,639,921$ 110,055,028$ 4.76% (Total Portfolio Yield) The Investment porfolio at June 30, 2024 is in compliance with the Investment Policy of the City of South Lake Tahoe. The City of South Lake Tahoe will be able to meetits projected expenditure requirements for the next six months. Valuation is based upon the State Treasurer's Office LAIF quarterly apportionment rates and US Bank Safekeeping. 2 of 2
54 CITY OF SOUTH LAKE TAHOE INVESTMENT REPORT
CASH AND INVESTMENTS HELD WITH FISCAL AGENTS
AS OF JUNE 30, 2024
BOND ISSUE CURRENT MATURITY
ACCOUNT INVESTMENT TYPE ISSUER COST VALUE MARKET VALUE YIELD DATE So Tahoe JPFA Lease Rev Bonds 2023 A Project Fund Dreyfus Gov Sec CM Inst 227 / U.S. Treasury Bill Dreyfus 56,561,888 57,041,403 5.25% N/A or 5/09/2024
to 11/29/2024
Lease Revenue Fund Dreyfus Gov Sec CM Inst 227 Dreyfus 28,918 28,918 5.15% N/A Cost of Issuance Account Dreyfus Gov Sec CM Inst 227 Dreyfus 30 30 5.17% N/A So Tahoe JPFA Ref Lease Rev Bonds 2016 A Lease Revenue Fund Blackrock Treasury Trust Bank of New York Mellon 247 247 5.21% N/A Interest Blackrock Treasury Trust Bank of New York Mellon 72 72 5.20% N/A Principal Blackrock Treasury Trust Bank of New York Mellon 542 542 5.21% N/A Reserve Assured Guaranty Municipal Bank of New York Mellon - 2 0.00% N/A So Tahoe JPFA Parking Rev Bonds 2013 Debt Service Account Blackrock Treasury Trust Bank of New York Mellon 17,279 17,279 0.00% N/ASo Tahoe JPFA Ref Rev Bonds 2014 A, 2015 A, 2017 A Revenue Fund Blackrock Treasury Trust Bank of New York Mellon 4,328 4,329 5.20% N/A Interest Blackrock Treasury Trust Bank of New York Mellon 2,636 2,636 5.20% N/A Principal Blackrock Treasury Trust Bank of New York Mellon 2,434 2,434 5.20% N/A Surplus Blackrock Treasury Trust Bank of New York Mellon 162 162 5.21% N/A So Tahoe JPFA (RPA 1) Reserve Blackrock Treasury Trust Bank of New York Mellon 5,317,049 5,317,049 5.20% N/ASuccessor Agency to the So Tahoe RDA, CFD 2001-1, Refdg Series 2015 Special Tax Blackrock Treasury Trust Bank of New York Mellon 809 809 5.20% N/A Interest Blackrock Treasury Trust Bank of New York Mellon 12,994 12,994 5.20% N/A Principal Blackrock Treasury Trust Bank of New York Mellon 216 216 5.21% N/A Reserve Blackrock Treasury Trust Bank of New York Mellon 591,770 591,770 5.20% N/A Surplus Blackrock Treasury Trust Bank of New York Mellon 259 259 5.20% N/A City of South Lake Tahoe 2014 Pension Obligation Bonds Interest Blackrock Treasury Trust Bank of New York Mellon 3,414 3,414 5.20% N/A Principal Blackrock Treasury Trust Bank of New York Mellon 1,714 1,714 5.20% N/ACity of So Lake Tahoe 2012 COPS, Road Improvmt. Lease Payment Fund First American Govt Obligation Fund/Money Mkt US Bank 14,930 14,930 4.78% N/A Reserve Account First American Govt Obligation Fund/Money Mkt US Bank 361,382 361,382 4.78% N/A TOTAL 62,923,073 63,402,591
Valuation is based upon the valuations contained in the monthly statements provided by the trust departments of the fiscal agents. 55 LAIF
55%
Medium Term
Certificate of Dep
1%
Government Agency
43%
Medium Term
Corporate Notes
1%
City of South Lake Tahoe
Operations Cash Investment Portfolio
Market Value as June 30, 2024
56 CITY OF SOUTH LAKE TAHOE
CASH REPORT
JUNE 30, 2024
FUND FUND NAME OPERATIONS CASH FISCAL AGENT TOTAL CASH TOTAL # BALANCE CASH BALANCE BALANCE OPERATIONS FISCAL AGENT CASH BALANCE 100 General Fund 33,698,319.27 $33,698,319.27
102 Measure S - Sales Tax (930,037.16) ($930,037.16) $32,768,282 $0 $32,768,282 201 Gas Tax 2105 734,309.57 $734,309.57
207 Snow Removal 450,575.48 $450,575.48
208 Snow Removal - Equipment Replac 1,347,002.86 $1,347,002.86 210 Vehicle Replacement 841,703.50 $841,703.50
211 Police Vehicle Replacement 593,951.39 $593,951.39
213 Fire Vehicle Replacement 335,544.45 $335,544.45
215 Disaster Relief/Prep 45,879.75 $45,879.75
216 Transit Center 79,720.09 $79,720.09
217 Arts Program 7,419.82 $7,419.82
218 VHR Program 386,798.33 $386,798.33
220 Parks and Recreation 15,876,506.61 $15,876,506.61
221 Ice Arena 53,256.71 $53,256.71
222 Fire Safety Sales Tax 461,572.67 $461,572.67
223 Cannabis Program 1,444,225.41 $1,444,225.41
224 PEG Programming 241,957.14 $241,957.14
229 DUI/Traffic Safety Grant 2,872.02 $2,872.02
230 Local Law Enforcement 1,994.32 $1,994.32
231 AB3229 COPS 232,945.67 $232,945.67
232 Safety Sales Tax (42,602.37) ($42,602.37)
233 Forfeiture - State Fund 39,528.75 $39,528.75
235 Forfeiture - Justice Fund 63,244.49 $63,244.49
236 EMS - JPA 319,694.49 $319,694.49
237 Boat Patrol - Grant 10,280.15 $10,280.15
238 Domestic Violence (DVRT) Grant 42,021.57 $42,021.57 240 Solid Waste AB939 (17,323.37) ($17,323.37)
241 Clean Community 35,182.49 $35,182.49
242 Vehicle Abatement 198,183.03 $198,183.03
243 Nuisance Abatement 192,902.00 $192,902.00
244 Solid Waste JPA 1,028,050.31 $1,028,050.31
245 Storm Water Mgmt/Sweeping 255,158.23 $255,158.23
250 Hsng&ED - Work Force Housing 1,177,181.13 $1,177,181.13 251 Hsng & Ed - Home 1,270,406.66 $1,270,406.66
252 Hsng & Ed - CDBG 130,141.12 $130,141.12
253 Hsng & Ed - Administration 321,157.38 $321,157.38
255 CDBG Program Income Loans 153,882.85 $153,882.85
256 CDBG Economic Development (212,691.94) ($212,691.94) 258 Calhome Loan Repayments 135,944.56 $135,944.56
263 TOT Revenue Fund 1,857,608.60 $1,857,608.60
270 General Plan/Community Plan 759,709.14 $759,709.14
271 Building Permit Fees 1,620,933.76 $1,620,933.76
280 Ski Run Business Improvement 11,395.86 $11,395.86
281 Measure S Maintenance Fund 66,831.97 $66,831.97
284 Measure S City Maintenance 367,361.97 $367,361.97
285 Tourism Improvement District (TID) 238,280.90 $238,280.90 290 Settlement Proceeds Sfty Programs 259,872.89 $259,872.89 $33,420,572 $0 $33,420,572 301 City CIP 22,025,590.91 $22,025,590.91
303 City CIP - Reg.Surf.Transp.Progr 204,513.75 $204,513.75 306 Rehab Water Quality Projects 2,629.63 $2,629.63
310 Long term Capital Replacement 257,024.79 $257,024.79 311 Campground Capital Outlay 310,196.94 $310,196.94
320 Housing - CIP Projects 397,506.42 $397,506.42 $23,197,462 $0 $23,197,462 401 City Debt Service 1,350,594.57 57,452,653.69 $58,803,248.26 $1,350,595 $57,452,654 $58,803,248 501 Airport 1,822,534.52 $1,822,534.52
510 Parking Management Bellamy 271,411.50 $271,411.50
515 Parking Management Plan 15,263.63 $15,263.63
520 Parking Garage 1,481,911.27 17,278.72 $1,499,189.99 550 Transit - Stage 583,666.90 $583,666.90 $4,174,788 $17,279 $4,192,067 601 Self Insurance - Health, Vision, Den 289,577.82 $289,577.82 602 Self Insurance - Workers Comp 6,981,890.04 $6,981,890.04 604 Payroll 754,555.17 $754,555.17
605 Health Insurance Savings 46,226.40 $46,226.40 $8,072,249 $0 $8,072,249 701 Trust 917.00 $917.00
707 Park Avenue CFD Fund 1,341,205.36 606,047.00 $1,947,252.36 711 Bijou ECP CFD 171,087.10 $171,087.10
712 Harrison Avenue CFD 222,654.63 $222,654.63
725 RD Obligation Retirement Fund 5,912,120.38 5,326,611.43 $11,238,731.81 751 Special Assessment District 4,572.00 $4,572.00
762 Tahoe Transportation Authority 3,416.00 $3,416.00 $7,655,972 $5,932,658 $13,588,631 Total Cash and Investments $110,639,921.25 $63,402,590.84 $174,042,512.09 $110,639,921 $63,402,591 $174,042,512
SUBTOTAL BY CATEGORY
57 City of South Lake Tahoe
Agenda Item Executive Summary
Joe Irvin, City Manager
__________________________________
Meeting Date: September 24,
2024
Agenda Item #:7
Agenda Item: Agreement with LWP Claim Solutions, Inc. for Workers' Compensation Third Party Administrator Services
Executive Summary: City Council will consider a contract with LWP Claim Solutions, Inc. for third-party administration services for the City's workers' compensation insurance program. The City is self-insured and uses a third party administrator to process and resolve claims. The proposed contract is for 5 years, and includes two additional 1-year extensions at the City's discretion. The proposed contract with LWP Claims Solutions includes a base annual fee of $89,000 for the first year plus additional charges based on additional services and managed care programs utilized, as outlined in Exhibit B of the proposed agreement.
Requested Action / Suggested Motions: Pass a Motion authorizing and directing the Mayor to execute a 5-year Professional Services Agreement with LWP Claim Solutions, Inc., for third-party workers' compensation administration services, for a base cost of $89,000 for year one with 3.5 percent annual increases thereafter.
Responsible Staff Member: Rebecca Penado, Risk Manager
Reviewed and Approved By: Susan Blankenship, City Clerk Olga Tikhomirova, Director of Finance Heather Stroud, City Attorney
Attachments:
01 - WC TPA Staff Report.docx
02 - LWP Professional Services Agreement.pdf
58 Council Agenda Report – September 24, 2024 Page 1 of 2 City of South Lake Tahoe
Report to City Council
Meeting Date: September 24, 2024
Title: Contract Award – Workers’ Compensation Third Party Administrator Location: Citywide
Responsible Staff Member: Becky Penado, Risk Manager 530-542-6064 Background:
The City of South Lake Tahoe has been self-insured for workers compensation since March 1993.
The city pays up to $500,000 for each claim. Any claim over $500,000 is paid by the City’s excess reserve insurance carrier (LAWCX).
The City engages a Third-Party Administrator (TPA) to manage its workers’ compensation claims.
In 1993, the City contracted with Gates McDonald, followed by Cambridge Integrated Services (“Cambridge) for TPA services. In June of 2011, Sedgwick Claims Management Services (“Sedgwick”) purchased Cambridge and became the City’s TPA. In October 2011, the City entered into a 3-year contract with Sedgwick which ended in 2014, followed by 4 one-year agreements with Sedgwick. In 2019, the City contracted with LWP Claims Solutions for TPA services after a competitive bidding process; the contract was for three (3) years with the option of two (2) one (1) year renewals. This year, after renewing the contract for those additional terms, the city initiated a Request for Proposals for Workers’ Compensation TPA Services.
Issue and Discussion:
In May 2024 a Request for Proposals was initiated for Workers Compensation Third-Party Administration via Planet Bid # 2024-07-15. The bid closed on July 15, 2024, and the City received five proposals from the following Third-Party Administrators:
1. American Claims Management
2. Innovative Claim Solutions
3. LWP Claims Solutions
4. Pegasus Risk Management
5. TRISTAR Claims Management Services
59 Council Agenda Report – September 24, 2024 Page 2 of 2 A selection panel comprised of Olga Tikhomirova, Finance Director; Rebecca Penado, Risk Manager; and Ember Buckman, HR Manager reviewed and scored the submittals based on the following criteria:
Cover Letter: 0-5 points
Executive Summary: 0-10 points
Company History, Background, Experience: 0-20 points
Scope of Work/Implementation: 0-35 points
Cost of Services: 0-25 points
References: 0-5 points
The scoring was as follows:
1. LWP Claims Solutions: 93.0
2. American Claims Management: 77.7
3. Pegasus Risk Management: 73.3
4. TRISTAR Claims Management Services: 68.0
5. Innovative Claims Solutions: 67.3
After the review process, the City determined that LWP Claims Solutions provided the highest scoring proposal and would be the best administrator to manage the city’s workers’ compensation claims program.
Financial Implications:
The annual claims administration fee is $89,000 for the first year of the contract and increases by
3.5% annually thereafter. Budget is available in the Workers’ Comp Insurance Professional Services FY24-25 account 602-01220-42020. This account is funded each budget year for workers’ compensation TPA services.
Environmental Considerations: This action is not a “project” subject to review under the California Environmental Quality Act (CEQA) under CEQA Guidelines section 15378(b)(5) (organizational or administrative activities that will not result in direct or indirect physical changes in the environment).
Policy Implications: This action is consistent with the City Council Strategic Plan 2023-2028 Strategic Priority 5, Core Services & High-Performing Government, by ensuring that workers compensation claims are processed efficiently so that employees who are injured on the job are not delayed in their recovery and return to work and the City’s workers’ compensation liability is mitigated.
60 CITY OF SOUTH LAKE TAHOE
PROFESSIONAL SERVICES AGREEMENT
This Agreement is made and entered into as of the 1st day of October 2024 by and between the City of South Lake Tahoe, a municipal corporation (“City”) and LWP Claim Solutions, Inc. (“Claims Administrator”).
RECITALS
A. Claims Administrator is specially trained, experienced and competent to perform the special services which will be required by this Agreement.
B. Claims Administrator possesses the skill, experience, ability, background, certification and knowledge to provide the services described in this Agreement on the terms and conditions described herein.
C. City desires to retain Claims Administrator to render professional services as set forth in this Agreement.
AGREEMENT
1. Scope of Services. Claims Administrator shall perform the services set forth in this Agreement and shall provide said services at the time, place, and in the manner specified in this Agreement. Claims Administrator shall have no power or authority by this Agreement to bind City in any respect.
The Claims Administrator agrees that it has satisfied itself by its own investigation and research regarding the conditions affecting the work to be done and labor and materials needed, and that its decision to execute this Contract is based on such independent investigation and research.
All services provided by Claims Administrator pursuant to this Agreement will be provided in accordance with the terms set forth in the Exhibit A, “Scope of Services,” attached hereto and incorporated herein by reference. Exhibit B, “Compensation Schedule,” attached hereto and incorporated herein by reference, outlines the fees and compensation which shall be paid pursuant to this Agreement.
Claims Administrator shall also adhere to all performance standards set forth in Exhibit D, “LAWCX Performance Standards for Claims Administrators”. 61 2. Term/Time of Performance. The services by Claims Administrator are to commence upon October 1, 2024, and continue for five (5) years, with two (2) one (1) year renewal options.
3. Compensation. Compensation to be paid to Claims Administrator shall be in accordance with the Schedule set forth in Exhibit B which is attached hereto and incorporated herein by reference. In no event shall Claims Administrator’s compensation, including travel and out-of-pocket expenses, exceed Exhibit B without additional written authorization from City. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to City at the time of payment. Payment is contingent upon compliance with all terms and conditions of this Agreement, as set forth herein. Claims Administrator shall obtain prior written authorization from the City for any costs in excess of budgeted amounts for each line item, task, or obligation under the Scope of Services.
4. Method of Payment. Claims Administrator shall submit monthly billings to City describing the work performed during the preceding month. Claims Administrator’s bills shall include a brief description of the services performed, the date the services were performed, the number of hours spent and by whom, the applicable hourly rate, and a description of any reimbursable expenditures. City shall pay Claims Administrator no later than 30 days after approval of the monthly invoice by City staff.
5. Extra Work. At any time during the term of this Agreement, City may request that Claims Administrator perform extra work. As used herein, “Extra Work” means any work which is determined by City to be necessary for the proper completion of the Project, but which the parties did not reasonably anticipate would be necessary at the execution of this Agreement. Claims Administrator shall not perform, nor be compensated for, extra work without prior written authorization from City.
6. Termination. This Agreement may be terminated by City or Claims Administrator immediately for cause or without cause upon ninety days (90) days written notice of termination. Upon termination, Claims Administrator shall be entitled to compensation for services performed up to the effective date of termination, and City shall be entitled to all work performed to that date.
Termination, revocation, or expiration of this Agreement shall not release either party from liability resulting from an event which occurred prior to such termination, revocation or expiration.
62 7. Ownership of Documents.
All plans, studies, documents and other writings, including working notes and internal documents, prepared by and for Claims Administrator, its officers, employees and agents and subcontractors in the course of implementing this Agreement, shall become the property of City upon payment to Claims Administrator for such work, and City shall have the sole right to use such materials in its discretion without further compensation to Claims Administrator or to any other party. Claims Administrator shall, at Claims Administrator’s expense, provide such reports, plans, studies, documents and other writings to City upon written request. All documents prepared by Claims Administrator are confidential and shall be maintained to preserve their confidential nature. Release of any such documents to third parties shall only be made upon written consent of City.
8. Claims Administrator’s Books and Records.
a. Claims Administrator shall maintain any and all ledgers, books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for services, or expenditures and disbursements charged to City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Claims Administrator for services provided pursuant to this Agreement.
b. Claims Administrator shall maintain all documents and records which demonstrate performance under this Agreement for a minimum period of three (3) years, or for any longer period required by law, from records shall be available at Claims Administrator’s address indicated for the date of termination or completion of this Agreement.
c. Any records or documents required to be maintained pursuant to this Agreement shall be made available for inspection or audit, at any time during regular business hours, upon written request by the City Manager, City Attorney, City Auditor or a designated representative of these officers. Copies of such documents shall be provided to City for inspection at City offices when it is practical to do so. Otherwise, unless an alternative is mutually agreed upon, the receipt of notices in this Agreement.
63 d. Where City has reason to believe that such records or documents may be lost or discarded due to dissolution, disbandment or termination of Claims Administrator’s business, City may, by written request by any of the above-named officers, require that custody of the records be given to City and that the records and documents be maintained at City offices. Access to such records and documents shall be granted to any party authorized by Claims Administrator, Claims Administrator’s representatives, or Claims Administrator’s successor-in-interest.
9. Independent Contractor. It is understood that Claims Administrator, in the performance of the work and services agreed to be performed, shall act as and be an independent contractor and shall not act as an agent or employee of City. Claims Administrator shall obtain no rights to retirement benefits or other benefits which accrue to City’s employees, and Claims Administrator hereby expressly waives any claim it may have to any such rights. All employees, agents, contractors or subcontractors hired or retained by Claims Administrator are employees, agents, contractors or subcontractors of Claims Administrator and not of the City.
City is not required to make any deductions or withholdings form the compensation payable to Claims Administrator under the provisions of this Contract, and is not required to issue W-2 Forms for income and employment tax purposes for any of Claims Administrator’s assigned personnel. Any third party persons employed by Claims Administrator shall be entirely and exclusively under the direction, supervision, and control of Claims Administrator. Claims Administrator hereby indemnifies and holds City harmless from any and all claims that may be made against City based upon any contention by any third party that an employer-employee relationship exists by reason of this Contract.
10. Interest of Claims Administrator. Claims Administrator, (and principals, associates and professional employees of consultant) covenants and represents that it does not now have any investment or interest in real property and shall not acquire any interest, direct or indirect, in the area covered by this Agreement or any other source of income, interest in real property or investment which would be affected in any manner or degree by the performance of Claims Administrator’s services hereunder. Claims Administrator further covenants and represents that in the performance of its duties hereunder no person having any such interest shall perform any services under this Agreement.
64 Claims Administrator is not a designated employee within the meaning of the Political Reform Act because Claims Administrator:
a. Will conduct research and arrive at conclusions with respect to his/her rendition of information, advice, recommendation or counsel independent of the control and direction of City or of any City official, other than normal Agreement monitoring; and,
b. Possesses no authority with respect to any city decision beyond rendition of information, advice, recommendation or counsel. [FPPC Reg. 18700(a)(2)].
11. Professional Ability of Claims Administrator. City has relied upon the professional training and ability of Claims Administrator to perform the services hereunder as a material inducement to enter into this Agreement. Claims Administrator shall therefore provide properly skilled professional and technical personnel to perform all services under this Agreement. All work performed by Claims Administrator under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily to be expected of competent professionals in Claims Administrator’s field of expertise.
12. Compliance with Laws. Claims Administrator shall comply with all applicable federal, state, regional and local laws, codes, ordinances and regulations in carrying out his/her duties under this Agreement. Claims Administrator shall observe and comply with all applicable laws, ordinances, regulations and codes of federal, state and local governments, and shall commit no trespass on any public or private property in performing any of the work authorized by this Agreement. The City, its officials, officers, elected officials, appointed officials and employees shall not be liable at law or in equity as a result of any failure of Claims Administrator to comply with this section.
In the event it is determined that the Claims Administrator is required to pay prevailing wages for the work performed under this Agreement, the Claims Administrator shall pay all penalties and wages as required by law.
13. Licenses. Claims Administrator represents and warrants to City that it has all licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Claims Administrator to practice its profession.
Claims Administrator represents and warrants to City that Claims Administrator shall, at its sole cost and expense, keep in effect or obtain at all times during 65 the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Claims Administrator to practice its profession.
Claims Administrator shall maintain a City of South Lake Tahoe business license at all times services are performed under this Agreement. Claims Administrator acknowledges that payments made pursuant to this Agreement may be withheld until this provision has been satisfied.
14. Indemnity. Claims Administrator hereby agrees to and shall indemnify and hold harmless City, its elected and appointed boards, officers, agents, employees and volunteers from and against any liability for any and all claims, demands, actions, losses, damages and injuries, direct or indirect (including any and all costs and expenses in connection therein), arising out of this Agreement or caused in any way by Claims Administrator’s negligent performance of this Agreement or its breach of its obligations contained in this Agreement, except for any such claims arising out of the negligence or willful misconduct of the City. Claims Administrator agrees to defend City from and against any and all losses, damages, claims costs and fees arising out Claims Administrator’s negligent acts, errors, omissions, regarding this Agreement, the Claims Administrator’s work under this Agreement, or the consultant’s Scope of Work.
City does not, and shall not, waive any rights against Claims Administrator which it may have by reason of the aforesaid hold harmless Agreement, because of the acceptance by City, or the deposit with City by Claims Administrator, of any of the insurance policies hereinafter set forth.
This hold harmless Agreement by Claims Administrator shall apply to all damages and claims for damages, or alleged to have been suffered, by reason of any of the aforesaid operation of Claims Administrator or any subcontractor, regardless of whether or not such insurance policies shall have been determined to be applicable to any of such damages or claims for damages.
Claims Administrator further waives any and all rights to any type of express or implied indemnity or right of contribution from the City for any liability, claims, demands, costs, charges and expenses and causes of action of whatsoever arising out of or in any way connected with this Agreement, and consultant’s work under this Agreement. Such waiver does not apply to any action taken at the express direction of City, outside of the specific terms of this Agreement. 66 15. Insurance Requirements.
a. Claims Administrator, at Claims Administrator’s own cost and expense, shall procure and maintain, for the duration of the contract, the following insurance policies.
i. Workers’ Compensation Coverage. Claims Administrator shall maintain Workers’ Compensation Insurance and Employer’s Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Claims Administrator shall require each subcontractor to similarly maintain Workers’ Compensation Insurance and Employer’s Liability Insurance in accordance with the laws of the State of California for all of the subcontractor’s employees. Any notice of cancellation of all Workers’ Compensation policies must be received by City at least thirty (30) days prior to such change.
Claims Administrator shall provide thirty (30) days written notice of nonrenewal of any Workers’ Compensation policies. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Claims Administrator for City. ii. Commercial General Liability Coverage. Claims Administrator shall maintain commercial general liability insurance no less broad than ISO form CG 00 01 in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. Coverage must be
made on the standard Occurrence form. Claims-Made forms are not acceptable without prior written consent of City. City of South Lake Tahoe must be endorsed as an additional
insured for liability arising out of ongoing operation by on behalf of Claims Administrator. If a commercial general liability insurance form or other form with a general
aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit.
iii. Automobile Liability Coverage. Claims Administrator shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Claims
67 Administrator arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence.
iv. Professional Liability Coverage. Claims Administrator shall maintain professional errors and omissions liability insurance for protection against claims alleging negligent acts, errors or omissions which may arise from Claims Administrator or by its employees, or subcontractors. The amount of this insurance shall not be less than one million dollars ($1,000,000) on a claims-made annual aggregate basis, or a combined singlelimit per occurrence basis. v. Employee Dishonesty. $1,000,000 to include comprehensive employee dishonesty, disappearance, theft, and forgery or alteration coverage in a form and issued by an insurance or bonding company or companies acceptable to CITY. Such
insurance shall not have a deductible greater than $1,000 any one (1) claim. Upon execution of an agreement, the TPA shall provide CITY with a certificate of insurance evidencing that such insurance has been obtained and is in full force and effect. Such coverage shall provide thirty (30) calendar days’ notice of intent to cancel or non-renew to CITY.
vi. Cyber Liability Coverage. Consultant shall maintain cyber liability insurance with limits not less than one million dollars ($1,000,000) per claim, two million dollars ($2,000,000) aggregate. Coverage shall be sufficiently broad to sufficiently broad to respond to the duties and obligations as is
undertaken by Vendor in this agreement and shall include, but not limited to, claims involving security breach; system failure; data recovery; business interruption; cyber extortion; social engineering; infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, and alteration of electronic information. The policy shall provide coverage for 68 breach response costs as well as regulatory fines and penalties, and credit monitoring expenses with limits sufficient to respond to these obligations. Vendor’s policy shall be primary and shall not seek contribution from the City’s coverage, shall contain a waiver of subrogation in favor of the City, and shall be endorsed to provide that City and its officers, officials, employees, agents, and volunteers are additional
insureds. Any failure to comply with the reporting provisions of the policy by Vendor shall not affect coverage provided to the City. If Vendor maintains broader coverage and/or higher limits than the minimums listed above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the Vendor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City.
b. Endorsements. Each general liability and automobile liability insurance policy shall be with insurers possessing a AM Best’s rating of no less than A:VII and shall be endorsed with the following specific language:
i. City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional
insured’s under Claims Administrator’s General Liability and Automobile Liability policies with respect to liability arising out of this Agreement and/or work performed by or on behalf of the Claims Administrator, including materials, parts or equipment furnished in connection with such work or
operations.
ii. This policy shall be considered primary insurance as respects City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by City, including any self-insured retention City may have, shall be considered excess insurance only and shall not contribute with it.
iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each,
69 except with respect to the limits of liability of the insuring Claims Administrator.
iv. The insurer waives all rights of subrogation against City except for Claims Administrator’s Professional Liability and Employers’ Liability policies, its elected or appointed officers, officials, employees or agents.
v. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to City, its elected or appointed officers, officials, employees, agents or volunteers. vi. No policies of insurance carried by Claims Administrator shall be suspended, voided, canceled, or changed in coverage or in limits except after thirty (30) days written notice to the City Attorney by Certified Mail.
c. Deductibles and Self-Insured Retentions. The Claims Administrator shall be responsible for all deductibles in all of Claims Administrator’s insurance policies. The amount of deductibles for insurance coverage required herein shall be reasonable and approved by the City Attorney.
d. Certificates of Insurance. Claims Administrator shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Claims Administrator shall not commence work under this contract until all insurance required under this section has been approved by City as to form, amount and carrier, nor shall Claims Administrator allow any subcontractor to commence work on any subcontract until all similar insurance required and reasonably consistent limits of the subcontractor has been so obtained and approved. Certificates of insurance shall contain no exclusions unless negotiated with the City Attorney and approved, in writing, by the City Attorney.
16. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below.
Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section.
If to City: City of South Lake Tahoe
1901 Lisa Maloff Way
70 South Lake Tahoe, CA 96150
Provide a copy to: City Attorney’s Office
City of South Lake Tahoe
Lisa Maloff Way, Suite 300
South Lake Tahoe, CA 96150
If to Claims Administrator:
Judy Adlam
President & CEO
LWP Claims Solutions, Inc.
35 Miller Ave. #214
Mill Valley, CA 94941
Provide a copy to:
Brian Esparza
Vice President- Claims
LWP Claims Solutions, Inc.
PO Box 340871
Sacramento, CA. 95834
17. Assignment and Subcontracting. The parties recognize that a substantial inducement to City for entering into this Agreement is the professional reputation, experience and competence of Claims Administrator.
Assignments of any or all rights, duties or obligations of the Claims Administrator under this Agreement will be permitted only with the express consent of City.
Claims Administrator shall not subcontract any portion of the work to be performed under this Agreement without the written authorization of City.
Upon City’s consent of any subcontract, Claims Administrator shall be fully responsible to City for all acts or omissions of the subcontractor. Nothing in the Agreement shall create any contractual relationship between City and subcontractor nor shall it create any obligation on the part of City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise required by law.
18. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement.
19. Dispute Resolution. Any dispute concerning this Agreement will be first submitted to the City Manager or his designee for resolution. If no resolution is reached, such dispute shall be submitted to the City Council. The decision of 71 the City Council shall be final and shall be appealable only to the El Dorado Superior Court pursuant to California Code of Civil Procedure §1094.5, and as provided by law.
20. Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in the Superior Courts in the County of El Dorado, South Lake Tahoe Division.
21. Prohibited Interests. Claims Administrator maintains and warrants that it has not employed nor retained any Claims Administrator or person, other than the independent contractors hired in accordance with Claims Administrator’s standard business practice, to solicit or secure this Agreement. Further, Claims Administrator warrants that it has not paid nor has it agreed to pay any Claims Administrator or person, other than a bona fide employee working solely for Claims Administrator or an independent contractor hired as discussed above, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom.
22. Equal Opportunity Employment. Claims Administrator represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, disability, ancestry, sex or age. Such nondiscrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. Claims Administrator shall also comply with all relevant provisions of City’s Minority Business Enterprise program, Affirmative Action Plan, or other related programs or guidelines currently in effect or hereinafter enacted.
23. Drug-Free Workplace Certification. By signing this Agreement, Claims Administrator hereby certifies under penalty of perjury under the laws of the State of California that the Claims Administrator will comply with the requirements of the Drug-Free Workplace Act of 1990 (Government Code Section 8350, et seq.) and will provide a drug-free work place by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution dispensation, possession, or use of a controlled substance is 72 prohibited and specifying actions to be taken against employees for violations, as required by Government Code Section 8355 (a). b. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b) to inform employees about all of the following:
i. The dangers of drug abuse in the workplace;
ii. The person’s or organization’s policy of maintaining a drug-free workplace;
iii. Any available counseling, rehabilitation and employee assistance program; and
iv. Penalties that may be imposed upon employees for drug abuse violations.
c. Provide, as required by Government Code Section 8355(c), that every employee who performs grant activities under this Agreement:
i. Will receive a copy of the Claims Administrator’s drug-free policy statement; and
ii. Will agree to abide by the terms of the Claims Administrator’s statement as a condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments under this Agreement or termination of the Agreement, or both, and Claims Administrator may be ineligible for award of any future City Agreements if City determines that any of the following has occurred: the Claims Administrator (1) has made false certification, or (2) violates the certification by failing to carry out the requirements as noted above.
24. Anti-Lobbying Certification. Claims Administrator shall submit to City the AntiLobbying Certification contained in Exhibit C. Further, Claims Administrator shall require that the language of the certification in Exhibit C be included in all contracts or subcontracts entered into in connection with this Agreement and that all Claims Administrator and contractors shall certify and disclose accordingly.
25. Debarment, Suspension, Ineligibility and Voluntary Exclusion. By signing this Agreement, Claims Administrator assures that neither it nor its principals, is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency.
73 26. Americans with Disabilities Act. By signing this Agreement, Claims Administrator assures the City that it complies with the American with Disabilities Act (ADA) of 1990, (42 U.S.C. 12101, et.seq.), which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to ADA.
27. Amendments. This Agreement may be modified or amended only by a written document executed by both Claims Administrator and City and approved as to form by the City Attorney.
28. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect.
29. Entire Agreement. This Agreement constitutes the complete and exclusive statement of Agreement between City and Claims Administrator. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement.
30. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart.
31. Time is of the Essence. Time is of the essence for this Agreement.
32. Authority to Enter Agreement. Claims Administrator has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party.
74 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above.
CITY OF SOUTH LAKE TAHOE: CLAIMS ADMINISTRATOR:
By___________________________ By ________________________________ Cody Bass , Mayor Judy Adlam, LWP President & CEO
Date __________________________ Date __________________________ Business License # __________________
APPROVED AS TO FORM:
By____________________________ Date __________________________ Heather L. Stroud, City Attorney
ATTEST:
By____________________________ Date __________________________ Susan Blankenship, City Clerk
Attachments:
Exhibit A – Scope of Services
Exhibit B – Compensation Schedule
Exhibit C - Anti-Lobbying Certification
Exhibit D – LAWCX Performance Standards for Claims Administrators 75 EXHIBIT A
SCOPE OF SERVICES
76 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
D. Scope of Work/Implementation (0-35 points)
The Proposer should identify the proposed implementation approach to include the following:
a) Indicate whether the Proposer can comply with the “SCOPE OF WORK” outlined in the RFP. If the Proposer is unable to comply with a specific performance objective, please indicate which objective cannot be complied with, the reason(s) the objective cannot be met and provide suggestions or alternatives.
LWP has carefully reviewed the Scope of Work, and is prepared to continue meeting all requirements, without exception. We have attached a document that contains detailed comments for each requirement in the Scope in order to assist the City in assessing our continued “fit” for your program.
b) Describe how your TPA ensures compliance with workers’ compensation statutes and rules and regulations promulgated by the Department of Industrial Relations.
At LWP, we know that a top‐to‐bottom focus on quality claims handling is where the rubber meets the road. Quality controls are woven throughout every aspect of our operations and provide the City with the assurance that everyone at LWP works diligently every day to keep all promises and meet all targets and deadlines.
LWP uses a multi‐pronged approach to ensuring quality claims handling that is outcome driven and never viewed as “processing”. Our approach includes:
1) Supervision
2) Automation
3) Separation of duties
4) Management reports
5) Internal Audit
6) SOC audit (External Audit)
Supervision: The Supervisor provides the first line of quality assurance. Our supervisors measure and monitor performance extensively to ensure that guidelines are followed, and steps are not skipped. In addition to their training and mentoring role, supervisors intervene in the adjusting process and play a pivotal role in ensuring quality claims handling.
Managers and Supervisors do not carry caseloads. It is central to LWP’s handling philosophy that Managers and Supervisors dedicate their time to overseeing the adjusting process. The Supervisor’s principal responsibility is to evaluate the examiners’ claims handling and provide feedback to ensure that all actions are proactive, timely, accurate and cost effective.
In addition to ensuring that a Supervisor reviews all claims at least every 90 days, we require Supervisors to sign off on a number of adjusting steps before Examiners can proceed. Supervisors are required to review and approve the following actions prior to completion. (Those approvals will be visible to Group through electronic access.)
77 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
▪ New loss assignment and direction
▪ Compensability approval (Accept, Delay, Deny) within 14 days) ▪ 28 day oversight diary
▪ Acceptance approval (if originally delayed)
▪ Reserve change approval (items over examiner’s designated authority) ▪ Settlement approval (items over examiner’s designated authority) ▪ Award computation sheet approval
▪ Penalty payments approval
▪ Regular oversight diaries at least every 90 days
▪ Closure approval
Team metrics are always available to our Supervisors through the use of data dashboards to ensure they are able to provide the best possible support to examiners. An example of a supervisor dashboard follows.
Automation: We have a number of controls built into our systems. A few of interest are the automated diary and email system; built in mail and document tracking; and built in authority safeguards.
Diary System: LWP’s claim diary system has some built‐in diary functions that add levels of safeguard to the claims management process. Those features include:
• System does not allow a claim to be open without at least one diary • Auto Diaries are created for new losses, each contact for three‐point contacts, supervisor’s 28 day review
• Auto diaries created for various client special handling requirements • System creates auto diaries to supervisors and managers when reserves are inadequate to make payments
• System creates auto diaries to supervisor and manager when reserve worksheet is created that exceeds examiners’ authority (reserves will not post until someone with sufficient authority approves)
• Diary history is maintained permanently in our claims system as an audit trail • State EDI exceptions are fed back into our system, and create auto diaries 78 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
Electronic Claim File/Mail Management: All mail is scanned and electronically date stamped on the date it is received. The mail is indexed and distributed to the Examiner by the next morning. All mail is flagged as “new” when it arrives in the Examiner’s mailbox. The Claims Handler acts on the mail by the date benefits are due, or within five business days from the date the mail was originally received by the office, whichever comes first. The document management system has an audit function that allows managers to know where a document has been at all times. There can be no lost mail!
Authority Safeguards: We have several built‐in safeguards against errors. First, we have built in authority levels set by Examiner that prevent a reserve from being posted without proper authority.
The Examiner enters their detailed reserve recommendation in our Reserve Worksheet screen. If the Examiner has sufficient system authority, the reserve will post. In cases where the recommendation exceeds the authority level, the claim system will automatically set a diary to the Supervisor, Manager, or Vice President, depending on the value of the recommended reserve. If approved, the reserve will post. If denied, the worksheet will be automatically returned to the Examiner for revision.
Similarly, payments cannot be released without reserves. The person entering the payment can complete the entry regardless of the reserve value; however, the check will not print. The system will set a diary for the payment request to a Supervisor and post the potential payment onto a report that is cleared daily by the Supervisors. The Managers and Vice President review this report regularly to ensure all payments are released timely. This also ensures that payments are not ignored, lost or misplaced.
Separation of Duties: We maintain strict separation of duties that conform to our SSAE 18 (formerly SAS 70) controls. A person who can approve a payment cannot enter one. Only our CFO can enter a vendor into our system, and the system will not produce a check unless the vendor is in our system and tied to a valid IRS Tax Identification Number.
Management Dashboards and Reports: Company‐wide reports are used to monitor compliance with Company performance standards. Examples are timeliness of set up, 3‐point contact, and insufficient reserve reporting. Additionally, we produce quality control reports to identify all data corrections and needs to conform to State EDI standards and to specific client data requirements.
Internal Audit: LWP utilizes an extensive internal audit program to ensure quality claims handling.
We have six staff members (4 with claims supervisory experience, and two with an accounting background) who perform internal audits. Our internal audit program is used to validate that we follow the guidelines we have set for ourselves. It very closely mirrors our SOC audit guidelines and serves as an internal validation that our controls are in place and functional. Our CFO, the three Claims experts and our Accounting Analyst audit various procedures and processes according to a schedule, and upon special request. Results are shared with our managers so that we can tighten any procedures necessary and can use our performance management system to address any individual performance issues that might be highlighted. 79 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
SOC 1 Type 2 Audit (External Audit): LWP was a very early adopter of the SAS 70 audit process, having earned our first annual SAS 70 Type 2 Audit certification in 2004. Annually, an accounting firm reviews our controls and objectives to test our compliance. Our most recent audit was completed in February 2024.
c) Provide a copy of the most recent Statement of Auditing Standards Report addressing your internal controls.
LWP was a very early adopter of the SAS 70 audit process, having earned our first annual SAS 70 Type 2 Audit certification in 2004. Annually, an accounting firm reviews our controls and objectives to test our compliance. Our 2023 SOC 1 Type 2 Audit is attached as Addendum D. d) Identify any owned and/or affiliated ancillary services, companies, etc.
LWP is a standalone Corporation with no subsidiaries or affiliates. e) In compliance with MMSEA Section 111 Medicare Secondary Payor Mandatory Reporting, CITY requires the selected TPA to be registered with the Centers for Medicare and Medicaid Reporting Services (CMS) as the Account Manager for CITY. The proposer will provide verification of their intention to register as the Account Manager and provide detailed information on their plan to provide necessary data to CMS within the required timeframes. Please specify any ancillary vendors which will be utilized for the transmission of data, any contractual arrangements between the proposer and the ancillary vendor, and any associated costs above the TPA claims administration costs for assuming the Account Manager responsibilities and data transmission as outlined by CMS.
LWP is currently registered as account manager for the City. LWP coordinates all Medicare and Medicaid set-aside agreements as well as ensuring all reporting is completed in compliance with Sections 111 of the MMSEA. Examworks acts as Account Manager/Reporting Agent for most of our clients, including the City of South Lake Tahoe.
f) Provide a comprehensive transition plan, including estimated timelines, to include the process for the transitioning of hard copy claim files to paperless claim files or paperless claim files to hard copy files if required.
Because LWP is currently the TPA for the City a formal transition will not be required. We will, however, work with the City to ensure that all org structures and coding meets the needs of the City. Should updates be required we will be happy to do those at this time. g) Describe any services not previously covered which you believe may be of particular value to CITY, such as provider and facility networks, litigation management, etc. 80 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
While we do believe that as the incumbent we have provided value to the City, we would like to take this opportunity to introduce a new program/tool as well as a new partner, both of which we we believe will enhance our services to both the City and to your employees. We are particularly excited about the impact LWP CareConnect can make in removing friction from the WC system for your employees.
LWP CareConnect: Beginning in August 2024 we will release the first phase of our new Injured Worker Engagement Platform. It will solve for some of the biggest obstacles in delivering support to injured workers:
• Communication barriers → Text, email, and secure/encrypted messaging with autotranslation • Time delays in initial investigation → Electronic questionnaires with risk alerts • Mitigating risk in real-time → Automated check-ins, escalation, and intervention • Delays in form exchange → Automated document delivery and eSign • Staying on top of treatment → Automated alerts, reminders, and follow-ups with appointment guides
• Uncertainty → Display key information, upcoming payments, FAQs, and more! We will automatically send a text message (or email) to injured workers at claims set up with basic information which will assist them throughout the life of the claim in being able to contact us and communicate issues or concerns. Also the injured worker will gain access to FAQs and other easiy valuable information which we hooe will assist in relationship development and successful communication. Injured Workers Engagement Platform
• Provides transparency
• Streamlines processes
• Empowers Injured Workers
• Identifies claim risks in real time
Key Features of LWP CareConnect
• Messaging
• Documents
• Appointments
• Automated support
• Psychosocial resources
• Jurisdictionally-specific FAQs
• Auto translates (100 languages)
We are very excited about enhancing our abilitiy to support injured employees as they recover and return-to-work.
Dayta Group Enhanced Investigations Services: While we know that most claims are legitimate and compensation, we also recognize that there are circumstances that warrant a deeper look. 81 Response to RFP – City of South Lake Tahoe
Submission Date – July 15, 2024
We have also recently formed a partnership with the Dayta Group. The Dayta Group has leading edge ideas and technology to assist in combatting fraud and mimimzing exposure for the City. Dayta Group focuses on fraud prevention and claim mitigation as evidenced by their groundbreaking solutions including VeriFive, iConfirm, and MedELink. They are woman-owned, California headquartered, fraud certified, licensed continuing education program providers, and SIU regulatory compliance experts. Dayta Group thrives on innovation, have technical claim expertise, are passionate about data, are relentlessly client focused, ensure operational excellence, and deliver LWP exceptional partnership execution.
Some of their differentiators are:
• Early, proactive investigatons focused on approaching employees early on in order to prevent fraud, rather than waiting, waiting, waiting.
• On-demand presentations to medical providers that leverage new technologies and AI to make the investigation review as simple as possible for the medical provider • Network of investigators available based on client preference and Dayta’s detailed due diligence
h) Samples of computer-generated reports must accompany as referred to in the “SCOPE OF WORK” in the RFP.
Samples of reports are attached as Addendum C.
82 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
WORKERS COMPENSATION CLAIMS ADMINISTRATION SERVICES SCOPE OF WORK I. SERVICES REQUIRED
The TPA shall provide CITY with sufficiently qualified personnel to efficiently and effectively meet the responsibilities as defined below and any other duties incidental, or in addition, to those responsibilities.
At LWP, we recognize that identifying the right staff for any particular client is part art, part science. LWP takes very seriously the process of matching the proper Examiner with the client. We consider ▪ Client culture and objectives
▪ Relevant experience
▪ Examiner’s caseload (both new loss volume and pending) ▪ Feedback from the client
We expect to continue to utilize the following staffing model:
1 Account Manager – partially dedicated
1 Claims Supervisor – partially dedicated
1 Claims Examiner - partially dedicated
1 Future Medical/Medical Only Examiner- partially dedicated 1 Claims Assistant – partially dedicated
Additional support (to include mail room, scanning, check printing, bill payment, trust fund replenishment and balancing and loss reporting) will be provided by our Centralized Services Team) Identifying Staff for City of South Lake Tahoe :
Amber Davis, Director of Claims- Public Entities, continues to act as your Account Manager. In her role, Amber ensures that our programs and protocols meet the City’s needs and are followed. She attends various meetings, including claim reviews, and is available to present cases to the City Council, if that is of interest. Together with Stacey Bean, she can also provide training and stewardship to the City staff. Amber Davis has unlimited authority to resolve issues on LWP’s behalf.
Amber joined LWP in 2003 as a Workers’ Compensation Examiner, having adjusted workers’ compensation claims since January 2000. She is a graduate of the Ricks College with Associate in Arts & Science. She holds the California Self Insured Certificate since 2003. She is a Certified Adjuster under the California Insurance Code and the California Code of Regulations. Amber was promoted to Claims Supervisor in 2008, Claims Manager in 2013 and Claims Director in 2022. She oversees all staff the support our Northern California public agency clients, and all public pools.
Amber Davis
Director of Claims
Public Entities
83 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
Stacey joined LWP in 2012 as a Workers’ Compensation Examiner. She had previously worked as the Workers’ Compensation Specialist for a Self-Insured employer in California for 11 ½ years. Stacey was promoted to Supervisor in 2017 and became an Assistant Manager in 2022. She earned Bachelors in Organizational Management Degree with distinction from Ashford University. She has held the California Self Insured Certificate since 2011. She is a Certified Adjuster under the California Insurance Code and the California Code of Regulations and holds other certificates related to Workers’ Compensation. Stacey works closely with Amber Davis, our clients and with the claims teams to provide support to our Northern California public agency clients, and all public pools.
We do have a team in place and would welcome your feedback on their “fit” for your program at any time..
The senior claims adjustors shall be state certified (SIP certification) and have a minimum of five years’ experience in adjusting workers’ compensation claims for public entities. The TPA shall also provide a supervisor who shall oversee the servicing of CITY’s claims. The supervisor shall be state certified and have at least 10 years’ experience in adjusting public entity workers’ compensation claims. The claims assistant shall have a minimum of 2 years claims experience.
The senior claims adjustor shall possess the following:
A. Time management and organization skills sufficient to prioritize tasks.
B. Knowledge of the Labor Code, 4850 benefits, presumptive injuries/illnesses and rules/regulations pertaining to public entities.
C. Exceptional written and verbal communication skills and negotiation skills.
D. Ability to develop relationships with specialty medical providers and ancillary service vendors.
As the incumbent, LWP does already have a Sr. Examiner assigned to the City. Her qualifications far exceed our standards, which we offer to the City for reference. When assigning an Examiners for the City, our standards are be:
• Minimum of 5 years Adjusting Experience
• 3 years’ Experience managing claims for Public Agencies • Licensed Self-Insured Administrator
• State Certified Examiner Status
• Receptivity to the City’s program needs
• Bilingual preferred
• Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
• Candidate must successfully pass LWP’s background checks (credit and criminal) Stacey Bean
Assistant Manager
84 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
The TPA shall provide adequate personnel for the claims unit as needed to cover vacation, illness, separation of employment, etc. No examiner(s) or supervisor outside the claims team shall service CITY’s account without prior approval by CITY.
We use a buddy system to provide seamless backup for all examiners. Examiners are paired based on complimentary work schedules and similarity of caseload. In staffing the City unit, we will ensure that all staff schedules (including PTO) are arranged to ensure at least one member of the unit is available to the City on every business day throughout the term of our relationship.
In the case of turnover or extended leave, LWP managers will develop a strategy customized to the specific needs of the situation. Our use of temporary adjusters is very limited. Because we have more faith and trust in our own staff members, we avoid use of temporary adjusters whenever possible. In fact, we have not utilized any temporary examiners in more than three years.
We work to hire staff ahead of our needs in order to have staff fully trained and ready to take on new business. We also look to hire staff members who are capable of, and interested in, career progression.
We will support their training objectives by investing in industry training and certification programs to prepare staff for the next level, and will allow them to shadow staff members to gain some experience prior to advancement. These employees are then available to step up during staff absences or vacancies and provide a ready pipeline of talent to fill vacancies as needed.
We notify the City of any resignation or other unplanned change in staff and work with you to develop a plan that meets your temporary and long term needs.
II. GENERAL PROGRAM ADMINISTRATION
TPA shall be licensed by the State Office of Self Insurance Plans and shall provide staff, professional, and clerical services, as required to administer a self-insured program in compliance with all rules and regulations governing the administration of self-insurance pursuant to State of California rules and regulations.
LWP is fully licensed, and maintains a valid Certificate of Consent to Administer Self-Insured Claims in California. All staff who serve the City will be fully certified to adjust claims for self-insured employers.
The TPA shall ensure each claims examiner handling CITY’s claims will receive continuing education training each year. The TPA shall annually certify the training received by each claims examiner in writing each April 1.
At LWP, we believe that training and development of our staff is critical to the success of our operation.
We believe that proper training is best accomplished through a combination of industry courses and seminars, professional designation programs and internal targeted training sessions. In fact, our owner and CEO, Judy Adlam served for six years on the Board of Directors of the Insurance Education Association (IEA.), serving for two years as Chair of that Board.
85 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
LWP goes well beyond meeting the statutory requirements for our staff. Our staff is 100% State certified, having all completed the initial required training, as well as a minimum of 24 hours of continuing education each year. Our training efforts do not stop there. Our advancement and promotional policies include a training component as well. No matter how exceptional an Examiner’s performance might be, they cannot be promoted without completing industry designations, including the Self-Insurance Certification. Not only do we ensure self-insured certification for all examiners who support self-insured clients, but many of our staff who support insurance carriers are also certified for self-insurance. This allows them to pinchhit and step in to assist other Examiners when necessary.
In addition to internal sessions, our staff are encouraged to participate in industry Seminars (including IEA), roundtables, and webinars, for which LWP reimburses all expenses.
LWP will certify training in writing by April 1 each year.
TPA shall conduct training in workers’ compensation laws, claims reporting and procedures, claims systems procedures, and orientation meetings for CITY members as requested.
LWP offers our clients customized Workers’ Compensation training. We will develop modules to meet specific requests. We are happy to commit to the three training sessions requested but are also happy to provide any additional sessions or training that the City may find helpful. We do not limit the number or frequency of training provided to any client and are happy to conduct the sessions remotely or in person.
Some topics of frequent interest to clients include:
- Introduction to Workers’ Compensation (WC 101)
- The role of the employer in WC claims
- The role of the supervisor in WC claims
- Strategies for Successful Return-to-Work
Additionally, for issues that impact all clients (ie. SB 1159), and route updates, as well as offering webinars.
These webinars are recorded so that we can offer the recording to clients who are unable to attend the actual sessions.
TPA shall provide CITY with information on changes or proposed changes in rules and legislation affecting CITY’s self-insured program.
If there is a law or regulation change that immediately impacts the City, we will ensure that the City is provided with the necessary information and recommendations to facilitate the change. We communicate changes and recommendations in a variety of manners, including:
▪ Webinars for clients (which we then record for follow-up listening) ▪ Presentations to client’s councils and boards
▪ Presentations conducted for clients in collaboration with law firms ▪ Information provided at claim reviews
▪ Distribution of industry bulletins to clients
86 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
TPA shall be responsible for all costs and penalties incurred as a result of its errors or delays in the administration of the claims. This includes, but is not limited to, its failure to determine compensability or to pay claims timely, self-imposed penalties, penalties imposed by the WCAB, or penalties imposed by other regulatory agencies.
LWP is very diligent about timeliness, and rarely incurs penalties. We voluntarily self-impose any penalty that results from our actions, and immediately reimburse our clients. Additionally, we will provide a full accounting of any penalties incurred, along with a plan that would include any remedial steps taken to avoid future penalties.
CITY reserves the right to request reassignment of vendors, subcontractors, or TPA employees that are not performing in a manner satisfactory to CITY. If the work is to be reassigned, CITY shall maintain sole discretion on reassignment.
LWP agrees that the City may request reassignment of any member servicing the account of the City should performance be unsatisfactory.
At LWP, we NEVER reassign adjusters, unless at the specific request of the client. The City can be assured that we will not make any changes.
At the same time, LWP manages performance diligently, including checking in with our clients to seek the client’s feedback on each team member’s performance. Should LWP identify a performance issue, we will reach out to the City to discuss our findings and agree on a proper plan of action, up to and including, removing the team member from the City’s team.
If the City is first to identify an issue, we will work with the City to determine what best serves the City’s needs, up to and including removing the team member from the City’s team.
TPA shall prepare and provide CITY with the OSHA 300 and OSHA 300A annual reports; prepare and provide CITY with the Public Self-Insurance Annual Report; and as requested prepare charts and graphs, perform statistical analysis of claim frequency and severity, loss trends, etc.
OSHA 300 and 300 A reports are available in our system. Data is automatically input into the report, and the reports are produced in Excel format, allowing the Client to edit the data to exclude any non-reportable claims, and to add any additional information to each claim. Report scheduling can be set to meet the City’s requirement of receipt no later than (30) days prior to due date.
Data is collected based on indemnity payment requests which capture the dates of disability. Additionally, Examiners track modified workdays in order to give the Employer a complete picture of Disability information.
At CITY’s request, the TPA shall make available all CITY claim files for independent audit. TPA shall fully cooperate with the audit and provide all information and data required to conduct and complete the audit.
87 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
At LWP, we view the claims as the property of the client. The City hasfull access to your claim files, allowing you to audit the claims at any time, without notice. We are also happy to invite auditors to visit our office at any time.
There is no additional cost for audit access or support.
The TPA shall implement a disaster recovery plan that is intended to secure, and if necessary, restore information adversely affected by a security breach, force majeure, or natural disaster. TPA shall make reasonable efforts to ensure that, at all times, it has a sufficient number of trained personnel on hand to meet its obligations under the Agreement including in the event of a force majeure, natural disaster, or pandemic.
LWP maintains a disaster recovery plan that is tested regularly. This includes testing our ability to restore data from a backup copy using offsite equipment.
As for data security and business continuity, our servers are all housed at Consolidated Communications in Sacramento, giving us the physical security and temperature control of a federally supervised TelCo company.
Our backups are done continuously using a disk-to-disk-to-cloud strategy. All Origami data is stored in the cloud, with Origami also maintaining full redundancy through a remotely located hot-site that can maintain all systems and data in the event of an outage at the main location. All LWP files (other than Claims data maintained in Origami) are encrypted and backed up nightly to the cloud, using Nasuni software to back up to the Amazon cloud. Amazon maintains backups in 4 redundant geographic locations to ensure no natural disaster can prevent accessibility. Cloud backups are 256bit AES encrypted with the encryption keys securely stored in multiple locations for redundancy. Backup can be accomplished remotely from any location so long as the program has the security keys.
As for redundancy, all servers are virtualized, allowing us to move instances from one server to another from any location.
Emergency backup is tested regularly, with our IT staff verifying that they can back up remotely from the cloud versions.
The TPA shall complete a file and data transfer, including IT conversion, from the incumbent TPA. All cost incurred for this data transfer and conversion shall be borne by the TPA.
LWP successfully completed a data transfer at the time of initial contract with the City, in 2019. As the incumbent, renewing with LWP will alleviate both the cost and distraction of any data transfer. 88 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
III. SCOPE OF WORK
1. Caseload
Each examiner shall have a caseload not to exceed 140 open indemnity claims. Each claims assistant shall have a caseload not to exceed 100 open future medical and medical-only claims. The supervisor shall not have an active caseload.
Indemnity Examiners manage no more than 125 claims at any one time, and 200 claims per Future Medical/Medical Only Examiner. Each supervisor oversees the work of 3-5 Examiners. Supervisors do not carry caseloads at LWP.
This is the case for LWP’s teams, in general, and is the case for the team that supports the City of South Lake Tahoe specifically.
The supervisor shall regularly review the work product of the examiners. Supervisor shall review 20% of the examiners’ caseload monthly and conduct comprehensive reviews of all claims with reserves in excess of $50,000.
The Supervisor provides the first line of quality assurance. Our Supervisors measure and monitor performance extensively to ensure that guidelines are followed, and steps are not skipped. In addition to their training and mentoring role, supervisors intervene in the adjusting process and play a pivotal role in ensuring quality claims handling.
Managers and Supervisors do not carry caseloads. It is central to LWP’s handling philosophy that Managers and Supervisors dedicate their time to overseeing the adjusting process. The Supervisor’s principal responsibility is to evaluate the examiners’ claims handling and provide feedback to ensure that all actions are proactive, timely, accurate and cost effective.
In addition to ensuring that a Supervisor reviews all claims at least every 90 days, we require Supervisors to sign off on a number of adjusting steps before Examiners can proceed. Supervisors are required to review and approve the following actions prior to completion. (Those approvals will be visible to Group through electronic access.)
▪ New loss assignment and direction
▪ Compensability approval (Accept, Delay, Deny) within 14 days) ▪ 28 day oversight diary
▪ Acceptance approval (if originally delayed)
▪ Reserve change approval (items over examiner’s designated authority) ▪ Settlement approval (items over examiner’s designated authority) ▪ Award computation sheet approval
▪ Penalty payments approval
▪ Regular oversight diaries at least every 90 days (Medical only and Indemnity) 89 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
▪ Regular oversight diaries at least every 180 days (Future Medical claims) ▪ Closure approval
Medical only and Indemnity claims are reviewed by Supervisors at least every 90 days, in addition to the action diaries and approvals noted above. Future Medical claims are reviewed at least every 180 days by the Supervisor. This results in a combined review of at least 20% of claims every month.
Noting that none of our Examiners have reserve authority in excess of $50,000, all claims with potential reserves of $50,000 or more are reviewed by the Supervisor prior to reserve approval, and then reviewed regularly on diary.
2. Forms
The TPA shall provide all forms necessary for the processing of benefits or claims information including the Employer’s Report of Occupational Injury or Illness (DWC Form 5020), Employee Claim Form (DWC Form 1), vouchers, checks, and other related forms. The cost of providing these forms shall be included within the contract price.
Agreed
3. Claim File Set Up and Diary Review
Upon receipt of the Employer’s Report of Occupational Injury or Illness, Application for Adjudication of Claim, or any other notice of a new claim, the TPA will prepare an individual claim file within one (1) business day for each claim. Preparation of the claim file shall include entering each new claim into the computer system and establishing a claim number. The file shall be available to CITY, including their representatives, claims auditors, and agents, for inspection and will contain all medical and factual information on each reported claim.
Recognizing that the City has been utilizing our portal to enter claims directly into Origami, we are happy to assist the City in entering new losses, if that is ever preferred. Once an incident is reported a claim supervisor will triage the potential claim and make the assignment to the adjuster along with specific recommendations based on the information presented. Claim files are set up electronically, usually within minutes of report. Claims are generally opened on the day received, but always within 24 hours of receipt.
Upon receipt, our New Loss coordinator verifies coverage and sends initial notices, including notifying the employer of the claim number and assigned Examiner.
All claim files shall be reviewed at least every 30 days for active claims and at least every six months for claims that have settled but remain open for the employee’s future medical care. The examiner shall distinguish the regular diary review from routine file documentation in the claim file. The supervisor shall monitor the diary reviews by printing a “No Activity” report each month to identify any files that have fallen off the diary system.
90 Scope of Services– City of South Lake Tahoe
Submission Date – July 15, 2024
All Active Claims can be reviewed by the Examiner no less frequently than at each Case Resolution Diary (every 30 days), and with the client at each claim review. Future Medical claims will be reviewed no less frequently than every 90 days. Claims Supervisors review the claims at least every 90 days.
The Supervisor Dashboard contains a list of claims with “no activity” within a prescribed period.
Supervisors review that list daily to ensure that all claims are being proactively moved to closure.
Each claim file shall contain the examiner’s plan of action for the future handling of that claim. The plan of action on new claims will be clearly documented in the claim file within ten (10) business days of initial claim set up. Such plan of action shall be clearly stated including the reasoning, strategy, and course of action(s) for the plan.
Initial plan of action is developed following the initial investigation, within 5 days from receipt of the claim.
We utilize a notepad template to ensure that the plan of action reviews are comprehensive and address all claims issues, including the exposure, compensability, temporary/permanent disability, medical treatment and prognosis and most importantly, the strategy and plan for case resolution.
Those notepad entries can be viewed by the City at any time.
We utilize a dual-track diary approach that achieves the diary objectives outlined by the City, by requiring both action diaries as well as plan-of-action diaries. Action diaries are set to find out immediately whether a planned event took place, so that we can ask for an update, and act quickly, often before reports are prepared. In addition to action diaries, every file has a “case resolution” diary, which is worked at least every 30 days for active cases, and at least every 90 days for future medical cases. By taking this approach, we are not only attending to all the various details of handling, but are continually mapping the road to closure, to ensure that all actions are leading us toward a swift resolution.
The plan of action will be updated at least every sixty (60) calendar days on active claims and at least every one-hundred eighty (180) calendar days for claims that have settled but are open to monitor future medical care. The plan of action shall include, but not be limited to accident history, current disability status, employee/claimant’s return to work status, medical status, type and duration of future medical care recommended by the applicable medical provider, litigation status, subrogation potential, detailed review of reserves, excess information, and future activity to move the claim towards resolution.
Agreed
4. Claim File Documentation
All activity, contact, notification, reconciliation, referrals, reviews, verification, etc., shall be clearly documented within one (1) business day and maintained in the applicable claim file. A copy of all 91 Scope of Services– City of South Lake Tahoe
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written documentation, notices, letters, reports, etc. will be maintained in the applicable claim file.
This requirement shall apply to all standards contained in this section of the document.
LWP prescribes to the old-fashioned notion that “if it isn’t documented, it didn’t happen.” We require that all communications be documented, and that all documents received and/or sent are maintained in the claim file. Our staff is required to document all activities on the day that they occur.
We offer our clients access to our claim files. All documents and claim notes and payments can be downloaded and/or printed at any time.
Use of electronic claim files is appropriate only with assurance that all claim file documentation can be recreated in hard copy as requested and access provided to the electronic claim files.
Agreed
5. Coverage
The TPA shall verify the coverage period and that coverage was provided to CITY on the date of injury or illness in accordance with program dates and governing documents. If applicable, the TPA shall exercise due diligence in joining applicable co-defendants. All activity to verify coverage and join co-defendants shall be clearly documented within one (1) business day.
Agreed
6. ISO
The examiner shall request a report from the ISO on all new indemnity claims. The TPA shall review and analyze all reports.
It is our Best Practice to report all indemnity claims to the Index Bureau (Verisk) and to follow up with a subsequent report every six months until a claim is closed. Examiners are expected to follow up to obtain relevant records for any claims identified on the report.
7. Employer Contact
The TPA shall immediately request the Employer’s Report of Injury form when or if notification of any injury or illness by any source is received first.
In cases where the Employer is not our first notice of an injury, we immediately reach out to the Employer to obtain all necessary information, including the Employer’s report of injury. We do not wait for the form but will add the documentation to the claim file obtained during the call.
If the DWC Form 1 has not been received by the TPA within two (2) business days after receiving the Employer’s Report of Occupational Injury or Illness, the examiner will contact CITY to ensure the 92 Scope of Services– City of South Lake Tahoe
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DWC Form 1 was given to the employee/claimant within one (1) business day of knowledge of the injury. If a DWC Form 1 was not provided to the injured employee/claimant, the TPA shall immediately send the DWC Form 1 directly to the employee/claimant.
This is our standard procedure.
The TPA shall contact CITY within one (1) business days of receipt of notice of a claim by any source to conduct an initial and meaningful investigation. The TPA shall confirm with the employer the number of employees on the date of injury. Such contact with CITY and information received from CITY shall be clearly documented in the claim file within one (1) business day.
LWP sets up claims and begins the three-point contact process immediately upon receipt of ANY notice of a claim. LWP examiners are required to make three-point contact on all Indemnity claims within 24 hours of receipt, with the first contact always being the employer. If voice-to-voice contact is not achieved, the examiner will continue efforts to reach the parties until accomplished.
All communications are clearly documented in the claims system, with the notes available for the client to view at all times. We always return phone calls to employees and the client within 1 business day, but generally return them within an hour or two.
When a claim reaches or exceeds $150,000 in total incurred value, the TPA shall automatically report to CITY every ninety (90) days regarding the status of the claim. Such report shall include the examiner’s plan of action for the future handling of the claim, and the current paid to date and total incurred amounts listed by indemnity, Supplemental Job Displacement Benefits, medical, and expense categories.
Agreed
The examiner will provide on-site, virtual, and/or telephonic file reviews for CITY total incurred value, including the preparation of claim narratives for those attending the meeting. Other periodic on-site file reviews will be scheduled based upon the needs of CITY.
LWP does not limit the number of claim reviews we offer. We believe that it is a very valuable tool in achieving superior claims outcomes and that the information that can be gleaned from the conversation makes the time and expense well worth the investment.
The most effective format is one that meets the client’s needs. Generally, we find it productive to have the Examiner present the claim (providing a brief written Plan of Action as well as a verbal plan to resolve the claim). The Examiner can then answer any questions and discuss strategies and options, with input from the Supervisor, Manager and of course, the client. We are happy to include Defense attorneys, or to schedule separate litigation reviews, if preferred.
Plan of Action reports are delivered electronically to you prior to the meeting. 93 Scope of Services– City of South Lake Tahoe
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We do believe that the meetings should be face-to-face, if possible, to maximize the benefits of collaboration.
Further, we are happy to conduct Stewardship meetings annually, or more frequently. Once we have collaborated with the City on a Stewardship reporting format, we are happy to produce it semiannually or quarterly, as preferred by the City. We can offer to review by in person, or by teleconference, if preferred.
Return phone calls to CITY and responses to e-mails will be accomplished within one (1) business day and clearly documented in the claim file within one (1) business day.
All telephone calls will be returned within 24 hours, with calls from injured workers returned same day, and generally within an hour or two. Each contact attempt will be documented in the notepad.
All correspondence from employers will be responded to within two (2) business days of receipt and clearly documented in the claim file within one (1) business day.
Agreed
8. Employee/Claimant Contact
In all non-litigated, lost time, or disputed cases, telephone or personal contact will be established with the injured employee/claimant within one (1) business day of receipt of notice of claim. Such contact will continue as often as necessary, but at least monthly. Any contact with the employee/claimant shall be clearly documented in the claim file within one (1) business day.
At LWP, we recognize that ongoing communications with injured workers is a key ingredient in avoiding litigation, returning employees to work and resolving claims quickly. Keeping injured workers informed of the process, their rights and what to expect significantly increases the likelihood of a successful outcome. We are committed to:
▪ listening first
▪ providing relevant, timely and appropriate communication to the Injured Worker ▪ addressing any concerns raised by the Injured Worker
▪ contacting the Injured Worker at least every two weeks while off work ▪ encouraging the Employer to stay in contact with the Injured Worker ▪ encouraging a prompt recovery
We view the Injured Worker as an extension of our Client and make every effort to extend the same level of customer service to the injured worker that we would provide our designated contact person for the Client. All calls from the Injured Worker will be returned the same day.
During initial contact with the injured worker the Examiner will introduce themselves, gather facts about the “who, what, when, where and how” of the claim for injury, provide the employee with an explanation of the benefits that he or she may be eligible to receive and answer any questions the 94 Scope of Services– City of South Lake Tahoe
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injured employee may have. We will make three phone attempts to reach the injured worker. If we are not able to reach the employee by phone, a letter is sent to provide the injured worker with the Examiner’s contact information and request the injured worker contact the Examiner as soon as possible.
In cases where the employee is losing time from work, the injured worker is contacted regularly (at least once each month, but generally every two weeks) to ensure that all parties are hearing the same information. During that period, we will stress the importance of reporting any income earned from other sources, so that we can properly determine benefits due.
It is our philosophy to maintain contact with injured workers who are not temporarily disabled as well.
At LWP, we understand that communication is the key to litigation prevention, and therefore, err on the side of making more contacts than are necessary, rather than under- communicating.
As required, the TPA will confer with and assist injured employees/claimants in resolving problems that arise from injury or illness claims.
At LWP, we take pride in preventing litigation by becoming a resource for injured workers. Rather than becoming an obstacle, LWP Examiners strive to remove obstacles in order to ease the process for the Injured Worker. We are always available to assist an injured worker.
We are further demonstrating our commitment to supporting injured workers by implementing an engagement tool as of August 1, 2024. The tool will allow texting directly with our claims team, upload of documents and will contain resources and Frequently asked questions for employees.
Return phone calls to employees/claimants will be accomplished within one (1) business day of receipt and clearly documented in the claim file within one (1) business day.
We always return phone calls to employees within 1 business day, and generally return them within an hour or two. We understand that injured workers can be sitting by the phone just waiting for us to respond, and respect both their time and the sense of urgency they may feel for an answer to their question or update on their claim.
All correspondence from employees/claimants will be responded to within two (2) business days of receipt and clearly documented in the claim file within one (1) business day.
Agreed
9. Reserves
Establish appropriate initial reserves within three (3) business days based on the information obtained at the time of claim set up. A copy of the detailed worksheet establishing the initial reserves shall be maintained in the applicable claim file and available for review by CITY. 95 Scope of Services– City of South Lake Tahoe
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At LWP, we take reserving very seriously. We recognize that one of our foremost responsibilities is to keep the client continually apprised of their potential liabilities. We understand the impact that reserves have on our client’s ability to assess their actual exposure.
During the initial case evaluation and no later than five business days from the date the claim is originally reported to us, the examiner will establish a reserve that reflects the likely cost of the case based on the available factual and medical information. Subsequent reserve changes are made within five calendar days of receipt of any additional information. It is our philosophy to ensure that the reserves represent the probable ultimate outcome based on available information.
We do not utilize any formula reserving, or any standard reserves. Whether it is a medical only or an indemnity claim, each claim is reserved based on the specific facts and circumstances surrounding the individual claim. Subsequent reserve changes will be made within 3 business days of receipt of any additional information supporting a reserve adjustment. It is our philosophy to ensure that the reserves represent the likely outcome based on available information.
Reserves shall be established based on the facts of the claim and the ultimate probable cost of each claim. All reserve categories shall be reviewed on a regular basis but not less than at least every ninety (90) calendar days. Such detailed reviews shall be clearly documented in the claim file within one (1) business day. Any changes to reserves shall include an explanation of the change. A copy of the reserve worksheet will be maintained in the applicable claim file and available for on-line review by CITY.
We stress reserve “accuracy”, rather than “adequacy”, as we recognize that reserves that are higher than necessary are as problematic as reserves that are insufficient. In the absence of specific guidelines from a client, our reserving policies and practices are:
Indemnity - Indemnity reserves are set based on our expectation of the indemnity that will be paid by the time the claim closes. Our indemnity reserve will be based on an estimate of the temporary disability, permanent disability and any vocational rehabilitation component.
Medical - The medical reserve will be based on the Examiner’s best estimate of the medical costs that will be incurred throughout the life of the claim, including lifetime medical care, if relevant.
Allocated Expenses - The Examiner will set a reserve for the expected expenses for all categories of allocated expense, including legal expenses, medical bill review, Utilization Review, copy service, investigations, etc. The Examiner will use all relevant information in order to project the costs, and will adjust the reserves within 5 days of changing information.
Future Medical - - Future medical reserves are set based on the anticipated level of future treatment.
Generally, this is developed by analyzing the most recent three years of medical care, and utilizing an average in order to project the costs based on the injured workers’ life expectancy. In cases where a pattern is not yet established, the Examiner will work with the client and excess carrier (if appropriate) to determine the proper reserve.
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Reserves are reviewed at every diary, no less frequently than every 30 days. Any time an inaccuracy is detected, a reserve worksheet is completed. The worksheet is reviewed by everyone involved in the approval process and is maintained as a permanent part of the electronic claim file. Each worksheet contains a detailed breakdown of estimated costs as well as an explanation for the rationale for the recommended reserves.
The TPA will monitor claims that have been settled via Stipulated Award or Compromise and Release with a provision for future medical treatment. Reserves for future medical treatment will be reviewed every 6 months and adjusted according to use over a three-year average and the injured employee’s life expectancy.
At LWP, we do not “monitor” future medical claims—we “manage” them. We review requests for medical treatment very carefully, considering medical necessity, consistency with the award (body part, type of treatment awarded, etc.) and possibility of new injuries. We work closely with excess carriers, and also look for opportunities to reduce the need for ongoing medical care, including weaning injured workers from long-term medication use.
Throughout the life of the Future Medical claim, we continue to do the following:
• Review the Award – to insure there has been no “creep” in the future medical treatment. We remain vigilant that no additional body parts or medications or treatment protocols are requested that are not consistent with the awarded treatment. • Review the P&S report on which the Award was based – This insures that any of our team members who review the claim accurately interpret the Awarded treatment. • Consider wean-down treatment to reduce dependency on pain medications – Overutilization of expensive medications is often the barrier to a cost-effective settlement of future medical cases.
Acknowledging that this can be a very difficult challenge, we have had some success in reducing the dependence on medications substantially enough to posture a case for a cost-effective settlement.
Compromise and Release settlements are considered at every juncture. Should the case require a Medicare Set Aside, we would consult with City to determine if it makes sense to consider a settlement. We believe that it is generally possible to predict the Medicare Set Aside values (at least a ballpark value) which can give City an indication as to whether there may be any interest in a settlement. If it is likely that the MSA would result in a prohibitively expensive settlement, we always recommend against pursuing the MSA.
We review reserves at every touch, and do a thorough reserve review at each plan of action review, at least every six month, reviewing the employee’s life expectancy, recalculating the three-year average and considering any changes in treatment patterns and/or other new information.
This review is clearly documented in the notepad and the rationale for any changes is further documented on the Reserve Worksheet. Both create permanent records in the claim file and are available for the Client to review electronically at any time. 97 Scope of Services– City of South Lake Tahoe
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The claims assistant shall have the authority to establish reserves up to $5,000. A senior claims examiner shall have authority to establish reserves up to $100,000. Reserves or changes in excess of $100,000 require CITY approval.
Agreed
10. Medical Administration
The TPA, absent a Medical Provider Network (MPN), shall coordinate with CITY to develop a panel of occupational medical facilities and high-quality general practitioners, specialists, hospitals, and emergency treatment facilities to which injured employees should be referred. The panel shall be regularly reviewed and updated.
We commit to continuing to work with the City to identify medical providers as needed. Given that the City is now utilizing our proprietary Medical Provider Network, we expect to continue utilizing our Network Development partner (Signature Networks Plus) to continue to source new resources for the City, as they become available.
The TPA shall assist CITY in identifying an industrial clinic and/or medical providers, if requested.
We are always available to assist the City in identifying clinics and providers as needed.
The physician’s office will be contacted within three (3) business days of notice of all new claims to conduct an initial investigation as to the medical aspects of the claim and discuss CITY’s return-towork goals. Such contact will continue as needed during the continuation of temporary disability to assure that treatment is related to a compensable claim and clearly documented in the claim file within one (1) business day.
It is our standard to contact the medical provider within 24 hours of receipt of a new claim and to make regular contact during the course of the treatment.
All contacts are documented in the notepad.
The TPA shall maintain contact with treating physicians to ensure employees/claimants receive proper medical treatment and are returned to full or modified employment at the earliest possible date.
LWP is committed to proactive disability management that is focused on early and sustained Returnto-Work. We recognize the need for early aggressive medical treatment so as to minimize disability and facilitate case resolution. We know that claims resolve quicker when the injured worker is returned to work. While an injured worker is disabled, we contact the treating physicians no less frequently than every two weeks. During the call, we attempt to coordinate release to full duty or, failing that, a return to modified or alternate work. Our staff is trained to probe for information about 98 Scope of Services– City of South Lake Tahoe
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what an employee is physically ABLE to do, rather than accepting “unable to return to work” as a status. We focus on activities of daily living to determine whether we can work with the employer to create modified duties based on those abilities.
By calling the treating providers, we eliminate the wait for reports that can significantly slow the progress of return to work and claim closure.
The TPA shall maintain direct contact with medical providers to ensure their reports are received in a timely manner.
Agreed
The TPA shall arrange medical evaluations when needed, reasonable, and/or requested in compliance with the current California Labor Code. In accordance with Labor Code Section 4601(a), the examiner will provide the employee/claimant with an alternative physician within five (5) business days of the employee/claimant’s request for a change of physicians. Such referral shall be clearly documented in the claim file within one (1) business day.
LWP does not believe in wasting time. Once we know there is a questionable or disputed medical evaluation, we will move quickly to take the next step. Depending on the circumstances of the claim and whether the claim is in litigation, we may recommend a QME or an AME. Generally, if the claim is a straight forward injury claim and we need to obtain a finding of “Permanent and Stationary” with a disability rating, we tend to pursue the panel QME so that we can invoke the statutory requirements for timely completion of the evaluation by the injured employee and timely completion of the report by the physician.
On more complex claims that include medical and legal issues, we will attempt agreement with a reputable AME physician if possible. We will also contemplate how far into the future the AME is scheduling evaluations as well as the anticipated turnaround time for the AME’s report before committing to an AME. LWP does this to mitigate any ongoing temporary disability/ salary continuation exposure and to keep the claim moving toward overall resolution.
The TPA shall make every attempt to utilize medical providers with contracts for negotiated rates to be paid less than the Official Medical Fee Schedule (OMFS) and/or recommended rates established by the Administrative Director of Workers’ Compensation.
We recognize that the City retains the right to select and approve all networks and partners. Upon contract award, we will meet with the City to review all recommended partners and networks.
LWP has a proven track record for “doing the right thing”, rather than merely “doing things right”.
Our focus is always on the successful outcome, rather than on the savings that can be generated by a single short-sighted transaction.
We maintain extensive cost-containment programs that are designed to first provide access to the best care available, and secondly, to offer cost savings where available. We review our claims and cost 99 Scope of Services– City of South Lake Tahoe
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containment results regularly to look for patterns that may allow us to fine tune our Best Practices in order to maximize the impact that cost-containment techniques have in the right situations while minimizing the costs and time that can be spent chasing savings that can be less than the cost of the process. Plainly stated, we will not spend a dollar to try to save fifty cents.
Once we have found the right care, we focus on the most cost effective way to access that care.
Preferred Provider Organizations (PPOs) : Through our partnership with accūrō, we access national and regional PPOs, to continuing to offer the City the best savings available. Through their ARC system, they are able to create a mosaic of networks in order to access the best possible savings for in various geographic areas.
Additionally, LWP has partnered with several specialty PPOs (including Optum for Pharmacy Benefit Network, One Call and HomeLink for Physical Therapy, and others) to deliver the best possible services at the best possible prices.
Durable Medical Goods: LWP utilizes Optum and One Call Medical, to access Durable Medical Equipment that is priced as much as at 38% below Fee Schedule or Usual and Customary, with no fee to Optum or One Call.
Expedited Diagnostic Testing: For diagnostic services, LWP has a strategic partnership with One Call Medical. The benefits of this arrangement are twofold- (1) preferential expedited appointments to speed diagnosis and treatment and (2) reduced fees for these services. Most tests can be scheduled within 24 hours to avoid the protracted delays that interfere with return-to-work and healing. There is no separate pricing for this program. Charges are no higher than fee schedule, without any additional administrative charge.
Transportation Program: LWP has a strategic partnership with One Call Medical. Their Relay-Ride program has resulted in very substantial savings by using an on-demand Lyft transportation model.
Their proprietary software allows them to schedule and communicate with drivers and injured workers in real time, offering the injured employee seamless services at a much-reduced cost.
Physical Therapy Network: LWP has formed a strategic partnership with Align Networks to offer access to their Physical Therapy Network. These services are contracted at 16% below fee schedule (8% for Concentra) , with no separate fee to Align. The benefits of utilizing a network are:
▪ Removes the financial incentive for physicians to over-prescribe, since the therapy will be performed at a facility in which the physician has no financial interest ▪ Consistency of reporting
▪ Discounted fees
Prescription Benefit Network: LWP has implemented an aggressive, multi-pronged approach to controlling Pharmacy Costs. The PPO portion of our program includes the following:
▪ No prescriptions can be filled in physicians’ offices ▪ First Fill cards provided to employer
▪ Both network discounts and out-of-network retrospective reviews ▪ Robust database that checks for drug interactions and non-formulary prescriptions to tighten dispensation and over-utilization
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Medical Provider Network (MPN): LWP’s proprietary MPN is unique in that is was built on a platform of PPOs, giving us the ability to carve out those medical providers that meet our standards for successful outcomes yet still deriving discounts that are uncommon in MPNs.
The TPA shall ensure that medical bills are reduced to at least the OMFS and/or recommended rates established by the Administrative Director of Workers’ Compensation. The use of a service contractor is acceptable provided approval is first obtained from CITY. CITY shall pay for the use and benefits of the services provided; however, fees charged by the service contractor shall have been approved by CITY prior to the provision of services. Such fees will be charged to the applicable claim file and will be paid from the appropriate category as determined by Office of Self-Insurance Plans (OSIP).
LWP offers bill review services that are provided in conjunction with our partner, accūrō, a leading national bill review provider. We have created a customized bill digestion system that adds a very significant level of quality control to accūrō’s product.
LWP’s bill review pricing is provided in the cost proposal, separate from the administration pricing, as requested. Our pricing includes LWP’s management fees as well as those fees that we pass along to accūrō. By partnering with accūrō, we gain access to their software and expertise, as well as access to various PPOs, including their customized ARC system, which includes their mosaic PPO blending product.
We are happy to provide a list of bill review fees on a monthly basis, prior to posting charges.
The TPA shall provide, at CITY’s expense, utilization review and/or professional managed care services on an as-needed basis to injured employees/claimants in compliance with Utilization Review approved guidelines. The use of a service contractor to provide this service is acceptable provided CITY’s approval is first obtained. Such fees will be charged to the applicable claim file and will be paid from the appropriate category as determined by OSIP.
One of the distinguishing features of LWP’s UR program is our judicious use of UR. As with all other things, LWP does not believe that more is necessarily better. In fact, unnecessary UR can serve to alienate treating physicians and injured workers and drive-up employers’ costs. We continually monitor each Examiner’s utilization to look for training opportunities. Examiners are encouraged to approve diagnostics and treatment that are very unlikely to be denied or modified. This can even include approving surgeries based on positive objective diagnostic findings. This approach is also consistent with our sports medicine philosophy to ensure aggressive, up-front medical care in order to speed the process from diagnosis to recovery.
At LWP, we carefully balance the need for accelerating medical care with the need to ensure that unnecessary treatment is prevented or curtailed as quickly as possible. We believe that UR should be used very sparingly, and that claims Examiners can approve significant amounts of medical care, particularly for diagnostic testing and routine care.
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During the past three years, LWP has approved nearly all treatment requests without the cost or delay of utilization review. For each of the last three years, our referrals have been:
Internal
Approvals
Referrals to
UR
% Adjuster
approved
21-22 149 9 94%
22-23 112 10 92%
23-24 105 1 99%
All medical treatment requests are flagged in our claims system for immediate review. Once reviewed, the Examiner can approve the treatment (if consistent with our protocols and the client’s guidelines) or can transmit directly to the Utilization Review partner. Examiners are encouraged to use the UR services at any time that they have questions or concerns about requested treatment. In the absence of specific concerns, though, our Examiners are permitted to approve the following procedures (subject to clients’ agreement):
Examiners are permitted to approve the following procedures (subject to client’s agreement):
• Diagnostic Tests Including: X-rays, CT Scans, MRI Scans, EMG’s and other tests as deemed appropriate
• 16 PT/Chiro visits or less for initial request or exacerbation • 16 PT visits post-op
• DME $1000 or less
• Specialist referral (including ortho, dentist, dermatologist, general surgeon, etc.) • Hernia repair surgery
• Knee and Shoulder arthroscopic outpatient procedures where objective findings are documented on diagnostic test results such as MRI, CT etc. • Non-Opioid Pharmacy requests under $600
• Opioids with estimated duration of less than 30-days
• Initial requests for steroid injections to joints (NOT ESIs) • Ultrasling, Polar Care unit for post-op shoulder
• Home Health Care in documented catastrophic losses
• Transportation
• Aquatic Therapy
• Electromyography (EMG) and nerve conduction velocity (NCV) testing • Trigger point injections
• Joint steroid injections
• Massage therapy
• Dental work
• Home health care/aides physical therapy/aides
• Skilled nursing visits
• Nursing home, skilled nursing facility, convalescent or residential care admissions • Orthotic device
Because LWP Examiners approve most straightforward treatment requests, our experience has proven that less than 30% of treatment requests that are sent to UR are approved at the nurse level. More 102
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than 70% of our referrals are escalated to the physician level and do result in treatment modifications or non-certifications, providing evidence that LWP does not inflate UR costs through unnecessary referrals.
Requests that may warrant a referral to the Utilization Review partner include:
• Physical therapy treatments in excess of 16 visits
• Occupational therapy treatments in excess of 16 visits • Hospital Admission (for other than surgeries listed above) • In-Patient Surgery (except as listed above)
• Outpatient Surgery (except as listed above)
• Chiropractic treatments in excess of 16 visits
• Pain Management
• Acupuncture in excess of 16 visits
• Possible Repeat or multiple diagnostic procedures to include magnetic resonance imaging (MRI) and computerized axial tomography (CT scan)
• Durable medical equipment greater than $1000
• Biofeedback and pain management, initial evaluation and “full” chronic pain management programs
• Weight loss programs
• Experimental treatments
• Functional Restoration programs
• Ongoing opioids, antidepressants, and addictive medications • Compound medications
Following is a flow chart of the process.
We are happy to discuss these guidelines at any time, if the City has questions or feedback.
11. Medical Payments
Medical bills will be matched to the file, reviewed for accuracy, and approved for payment within the time limits established by Labor Code Section 4603.2. If all or part of the bill is being disputed, 103
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the TPA will notify the medical provider, on the appropriate form letter, within the timeframe established by the Labor Code Section 4603.2.
LWP has built an integrated approach to Bill Review that leverages our claims technology and our advanced knowledge of bill review pricing and quality control with our partnership with accūrō a “Best in Class” vendor who maintains exceptional bill review software, staff expertise and jurisdictional updates.
Over the years, we have continually refined our internal controls and system edits in order to offer our clients a very substantial added layer of quality control that sits on top of the Bill Review Company’s offerings, offering this combined program through “SPHERE Solutions,” our trade named Managed Care arm.
LWP takes extensive steps to ensure that medical payments are appropriate and timely made. Those steps include:
▪ Timely use of Utilization Review, where appropriate (LWP’s UR plan allows the Examiner more flexibility to approve treatments without the necessity for UR. We believe that UR can be a valuable tool for evaluating complex treatments but serves to delay treatment and drive up costs if overused.)
▪ LWP approves all bills for payment PRIOR to sending to bill review. We do this so that our clients do not incur bill review charges for bills that should legitimately face objections. In ▪ 2023 we saved our clients more than $420,000 in bill review fees that were not incurred because LWP filed an objection BEFORE sending the bills to bill review. ▪ Proprietary bill processing workflows that provide an advanced interface between our claims system and the bill review software.
Our integrated LWP/accūrō protocol is as follows:
1. Bill is received in our Sacramento location (via either email, fax, mail or upload from a provider’s FTP site)
2. The bill is scanned on date of receipt and indexed within 24 hours.
3. The image is then presented to the Examiner for approval in the Claims system.
4. Approved images are uploaded to a secure FTP site for pick-up by accūrō. Each file has a descriptor that has the number and image ids included.
5. The bill data is entered into accūrō’s ACT bill review system, the system checking against the required data elements and previous bill review history for possible duplication. 104
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6. Once cleared for processing, each line of the provider bill is input for compliance to the fee schedule and sent to audit for accuracy of the coding. It is noteworthy that accūrō does not auto-adjudicate bills. Every bill is reviewed by a human…a trained, certified bill reviewer.
7. When the bill is determined to be correct, it is pended and transmitted to all affiliate networks for possible further contracted network reductions.
8. Once a bill is returned from the Networks, the accūrō bill reviewer finalizes the reductions, processes an EOR and sends a file back to LWP in a daily electronic feed, which is posted to a secure FTP site.
9. Once a bill (with the corresponding EOR) is returned from the bill review software, it automatically uploads to our Check Validation queue, where it must pass through a series of automated and manual checks to verify accuracy and appropriateness. Those checks include a systematic check to ensure the following:
▪ Bill has been approved by the Examiner
▪ Payment is being made on the correct claim
▪ Provider has valid W9 on file
▪ There are no overlapping or duplicate payments that have been missed by the bill review software (as checked by procedure code, provider and dates of service) ▪ Check does not exceed client’s special funds threshold ▪ Client does not have special payment procedures
10. Once all verifications are completed (some are automated and some require claims experts verify), system will issue a check. EOR will print along with the check.
Through our partnership with accūrō, the City will have access to all major PPOs, including accūrō’s mosaic product, which can be customized to blend together the PPOs that offer the best savings in the geographic area. They update networks continually as well as updating fee schedule changes immediately upon release.
Additionally, LWP has partnered with a number of specialty PPOs (including Optum for Pharmacy Benefit Network, One Call Networks for Physical Therapy, and others) to deliver the best possible services at the best possible prices.
By combining LWP’s advanced bill management protocols and systems with our partners’ significantly discounted pricing, the City will enjoy powerful savings in medical costs.
LWP has built a detailed bill-processing queue that performs extensive checking before bills are paid.
Once a bill is approved, it is either automatically uploaded to the bill review software, or routed to our Straight Pay engine if the bill is not eligible for bill review (i.e. legal bill, UR bill, Interpreters bill, etc.) 105
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For bills that are subject to bill review, our IT staff tracks each bill based on a document tracking number assigned at the time of initial receipt. That bill can then be tracked throughout the system, and can be searched in the Bill Review software if necessary.
Once a bill is returned from the bill review software, it is automatically uploaded to our Check Validation Queue where it must pass a series of automated and manual checks. Those checks include a systematic check to ensure the following:
▪ Bill has been approved by the Examiner
▪ Payment is being made on the correct claim
▪ Provider has valid W9 on file
▪ There are no overlapping or duplicate payments (as checked by procedure code, provider and dates of service)
▪ Check does not exceed client’s special funds threshold ▪ Client does not have special payment procedures
Additionally, a Supervisor must release each payment individually if they are caught in the queues based on:
▪ Claim is in delay or deny status
▪ Claim is coded as a “companion” claim
▪ Claim is coded as “first aid”
LWP understands the importance of accurate bill review, and also understanding the importance of clear and straightforward bill review fees. LWP has provided bill review fees that we believe to be fair, straightforward, and very competitive. We are committed to providing pricing that never produces any surprises.
In the case of a disputed bill appropriate notice will be sent to provider.
Late payments must include the self-imposed increase and penalties in accordance with the Labor Code. Reasons for the late payment shall be clearly documented in the computer notepad within one (1) business day.
We consider this to be a core responsibility. Although penalties are rare at LWP, we do self-impose 10% penalties whenever a payment is late. Additionally, we will provide the City with an action plan to communicate steps we will take to prevent any further occurrences.
The TPA shall ensure that medical bills are reduced to the Relative Value Schedule (RVS) and recommended rates established by the Administrative Director of Workers’ Compensation. The use of a bill review vendor to provide this service is acceptable upon CITY’s approval. CITY shall pay for the use and benefits of the services provided; however, fees charged by the vendor shall have been approved by CITY prior to the provision of services.
LWP understands the importance of accurate bill review, and also understandsthe importance of clear and straightforward bill review fees. LWP has provided bill review fees that we believe to be fair, 106
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straightforward, and very competitive. We are committed to providing pricing that never produces any surprises.
12. Compensability
The compensability determination (accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination will be made and documented in the claim file within two (2) business days from the receipt of the notification of the loss by the TPA. Delay of benefit letters shall be mailed in compliance with the Department of Industrial Relations’ guidelines. A copy of all benefit letters will be provided to the members. Copies of benefit notices will be maintained in the applicable claim file. The TPA shall notify CITY of delay or denial of any claim.
At LWP, we recognize that claims investigation begins with the three-point contact. LWP Examiners are required to make three-point contact on all Indemnity claims within 24 hours of receipt, with the first contact always being the employer.
Examiners are trained that a prompt and thorough investigation answers the questions of “who, what, when, where, why and how.” A prompt inquiry to determine the facts while the events are still fresh in everyone’s mind promotes the Claims Examiner’s ability to control and coordinate management of the claim. They are trained that claims investigation is critical to determining issues of employment, compensability, benefits, subrogation and safety hazards or violations.
LWP recognizes the importance of cost controls. LWP claims staff will complete the initial claims investigation and any telephone investigation. Should the initial investigation uncover information that warrants field or face-to-face investigation, the Examiner will request client approval before referral to a field investigator or SIU investigator.
Although we can certainly commit to making all compensability decisions within 2 days of receipt, we do believe that using the full 14 days allowed by statute can allow for more complete compensability decisions with fewer claims places on “delay”. LWP believes in being very judicious about delaying and denying claims. We know that unnecessary delays are an almost certain trigger for litigation.
Therefore, we encourage immediate reporting of losses by the Employer so that we have nearly a full 14 days in which to complete an investigation. By using the 1st 14 days carefully, we can generally fully complete the compensability investigation without the need for filing a Delay of Benefits, thereby containing the litigation exposure to just those claims that should be legitimately denied. Upon contract award, we will work with the client to agree on the approach that works best for the client.
In cases where the client has agreed that a delay is appropriate, LWP will make a final compensability recommendation to the client well ahead of the 90 day limit.
In no case shall a final compensability decision be extended beyond ninety (90) days from CITY’s date of knowledge of the claim, without consultation with CITY. 107
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Agreed
The examiner must seek prior authorization from CITY to delay or deny any claim or to accept a claim from delayed or denied status.
For questionable compensability issues, we will strive to complete our investigation within the 1st fourteen (14) days to avoid the need to delay the claim. We find that it is often possible to accomplish this, and to make the determination whether to accept or deny without a delay. By doing this, we can often prevent the litigation that may come from a delay of a claim that will ultimately be accepted.
The City is always consulted before a delay or denial of any benefit on a claim, including medical treatment. This includes consulting with the City before denying treatment as a result of a Utilization Review non-certification.
13. Investigations
CITY shall be notified of the need for an outside investigation as soon as possible. With authority from CITY, the TPA shall promptly initiate investigation of issues identified as material to potential litigation and subrogation recovery. CITY shall be kept informed on the scope and results of all investigations. All activities and communication with CITY shall be clearly documented in the claim file within one (1) business day.
Separate from any indications from you that would trigger a potential referral for surveillance; we believe that there are several criteria that can be indicators that a field investigation and face-to-face statement taken from the injured worker may be indicated. Those criteria include:
▪ Employee’s account of incident changes as it is retold ▪ Employee claims to have “forgotten” to report an important mechanism of injury ▪ Employee’s initial account differs from physician’s First Report of Injury ▪ Employee fails to report the injury in a timely manner ▪ Lack of physical evidence to support claims
▪ Alleged injuries appear to be physically impossible
▪ Mechanism of injury is inconsistent with alleged injuries ▪ More suspect if incident reported after days off
▪ Monday morning report of a Friday injury
▪ Claim filed more than a few days after the alleged injury 108
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▪ Claim occurs in conjunction with layoffs or announcements of changes ▪ Claims occurring after termination
▪ Multiple prior claims
▪ Frequent address or phone changes
▪ Using a PO Box as a home address
▪ Worker uses addresses of friends, family, or PO Boxes; has no known permanent address and moves frequently.
▪ Inability to contact claimant at home when totally disabled ▪ New hire at employer
▪ Chooses treating physician that is significant distance from employee ▪ Tries to treat outside the MPN
▪ Upcoming job change or seasonal layoff immanent
▪ Worker reports an alleged injury immediately following disciplinary action, notice of probation, demotion, or being passed over for promotion ▪ Worker has known high-risk activity, such as mountain climbing or snowboarding ▪ Worker avoids the use of U.S. Mail; hand-delivers documents ▪ Employee is known to have simultaneous employment
Potential fraud is always discussed with the City prior to any referral. If approved, the results of the investigation will then be discussed with City, and together, we can determine the best strategy for utilization of the findings. City will be involved every step of the way.
14. Provision of Benefits
The TPA shall provide all compensation and medical benefits in a timely manner and in compliance with the statutory requirements of the California Labor Code. The TPA shall compute and pay temporary disability benefits to injured employees/claimants based upon earnings information and authorized disability periods. The TPA shall review, compute, and pay all informal ratings, death benefits, Stipulated Awards, Findings and Awards, life pensions, or Compromise and Release settlements.
LWP has extensive protocols to ensure that we determine eligibility for, and then process both medical and indemnity benefits in a timely manner.
Indemnity Benefits: LWP makes contact with the City, treating physician and injured worker within 24 hours of receipt of a lost time claim and follow up regularly to ensure that all indemnity payments are justified. We make contact with all three regularly in order to ensure all steps are being taken to return the employee to work as quickly and safely as possible.
LWP’s regular contacts with the treating physician are focused on determining what activities the employee is ABLE to perform. We do not accept “unable to work” as a status. We look for the activities 109
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that CAN be performed, including activities of daily living. We will then work with the City to determine whether temporary modified work can be available to keep the employee at work.
Settlement: LWP requires Examiners to complete a settlement worksheet that details all calculations (including PD advances, etc.) Settlement worksheets must be approved by the Supervisor before the settlements are paid.
Medical Benefits: LWP takes extensive steps to ensure that medical payments are appropriate and timely made. Those steps include:
▪ Timely use of Utilization Review, where appropriate. We believe that UR can be a valuable tool for evaluating complex treatments, but serves to delay treatment and drive up costs if overused.) ▪ LWP approves all bills for payment PRIOR to sending to bill review. We do this so that our clients do not incur bill review charges for bills that should legitimately face objections. In 2023 we saved our clients more than $420,000 in bill review fees that were not incurred because LWP filed an objection BEFORE sending the bills to bill review.
▪ Proprietary bill processing workflows that provide an advanced interface between our claims system and the bill review software
CITY shall establish a Trust Account from which such benefits are paid. All checks issued in the amount of $3,500 or above shall require CITY’s signature. The claims administrator shall provide CITY with monthly detailed accounting of the expenditures from the Trust Account and reconcile the account at the direction of CITY.
As the incumbent, banking arrangements are already in place, alleviating the need to utilize the City’s resources to setting up these processes.
Having said that, we are also happy to revisit the trust accounting procedures, if there are any aspects of the process that can be made easier for the City to manage.
At LWP we believe that our clients should have control over banking relationships. While we have many different methods of calculating advance funding a standard would be to fund a trust account with 6 weeks average payments and then replenish once a month within about a two week window to allow for consistent movement of payments.
LWP has a dedicated banking team that is always available to the City. The team can provide any reporting needed, both scheduled and ad hoc. We regularly reconcile accounts (by the 15th of each month, unless required earlier by a client), analyze the funding adequacy, provide historical reporting as well as recommendations and support. The City can modify your banking arrangements at any time.
We routinely provide check stock, manage replenishments, build and manage two-way positive pay feeds to various banks, and provide all accounting and reconciliations. We can provide both standard and customized reports to meet the City’s accounting needs. 110
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LWP takes very seriously our responsibly for financial integrity. Among the many actions we take to ensure quality and fiscal integrity are:
▪ Reconciliation of accounts every month
▪ Implementation of positive pay for client checking accounts ▪ Careful separation of duties to limit the opportunity for fraud ▪ Automated duplicate checks on payments even on bills that have been through bill review ▪ Supervisory oversight of reserving including automated safeguards on the amount of reserve changes including client involvement on large transactions ▪ Adjuster approval of all bills prior to payment or bill review with extensive audit trails ▪ Extensive management reports on system access, roles, and authorities ▪ Automated data integrity checks in both medical and straight pay ▪ Double-blind keying of straight pay bills
▪ Payment checks on medical bills
▪ Vendor W-9 setup by two individuals with no ability to make payments ▪ Validation of tax ids against the IRS database
▪ All client data feeds are cross checked against loss runs at specified time intervals TPA service fees are never paid from the trust account, but rather are invoiced directly to the City separately.
15. Allocated Loss Expenses
All allocated loss expenses shall be the responsibility of CITY. It is agreed and understood that, whenever practicable, allocated loss expenses should be paid directly from the applicable claim file.
The above fee arrangement shall include all services included in this RFP except for payments made by the TPA on CITY’s behalf for medical, disability, or other benefits, and allocated loss expense.
Agreed
Allocated Loss Expense shall mean all WCAB or court costs, fees, and expenses; fees for service of process; fees to attorneys; fees of independent adjusters or attorneys for investigation or adjustment of claims for AOE/COE investigations not performed by the TPA’s workers’ compensation claims personnel; the cost of employing experts for the purpose of preparing maps, photographs, diagrams, chemical or physical questions; the cost of copies of transcripts of testimony of coroner’s inquests or private records; the cost of depositions and court reporter or recorded statements; and any similar costs or expenses properly chargeable to the defense of a particular claim or to the protection of the subrogation rights of CITY; provided, however, that all of the above services performed by the TPA’s personnel shall not be considered allocated loss expenses unless CITY is informed by the TPA that an AOE/COE investigation is necessary and CITY requests, in writing, that the TPA perform that investigation; the TPA personnel can then perform the investigation and the costs of that investigation shall be considered as allocated loss expenses. If CITY does not request the AOE/COE investigation be performed by the TPA personnel, such investigation shall be referred by the TPA to an independent investigator.
Agreed
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Allocated loss expense shall also include medical cost containment program costs as defined in Title 8, Division 1, Chapter 8, Subchapter 2, Article 6, and Section 15300.
The Examiner will set a reserve for the expected expenses for all categories of allocated expense, including legal expenses, medical bill review, Utilization Review, copy service, investigations, etc. The Examiner will use all relevant information in order to project the costs, and will adjust the reserves within 5 days of changing information.
16. Initial Indemnity Payment
The initial indemnity payment or voucher will be issued and mailed to the injured employee/claimant or employer, if appropriate, together with a properly completed DWC benefit notice within ten (10) business days of the knowledge of the first day of disability. Copies of benefit notices will be maintained in the applicable claim file with a copy to CITY if not previously provided.
Agreed
Late payments must include the self-imposed increase in accordance with the Labor Code. Reasons for the late payment shall be clearly documented in the computer notepad within one (1) business day.
We consider this to be a core responsibility. Although penalties are rare at LWP, we do self-impose 10% penalties whenever a payment is late. Additionally, we will provide the City with an action plan to communicate steps we will take to prevent any further occurrences.
All indemnity payments subsequent to the first payment will be verified, except for obvious longterm disability, and issued in compliance with Labor Code Section 4651.
It is LWP’s practice to contact relevant parties before checks are issued, except in the case of very longterm disability. We understand that timely, accurate issuance of benefits and notices is a core responsibility.
CITY participates in the PERS retirement system and shall pay Labor Code 4850 benefits. CITY reimburses only Temporary Disability benefits.
LWP is very familiar with administering LC 4850 benefits and with supporting the City’s PERS retirement IDRs. We understand PERS specific requirements for medical reporting, utilizing specific specialties for specific injuries. We will continue to work to streamline the medical reporting process so that the City has the information needed to proceed to an IDR, when appropriate.
17. Subsequent Indemnity Payments
All indemnity payments or vouchers subsequent to the first payment will be verified, except for obvious long-term disability, and issued timely in compliance with the Labor Code. Copies of benefit 112
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notices issued with subsequent benefits will be maintained in the applicable claim file with a copy to CITY.
It is LWP’s practice to contact relevant parties before checks are issued, except in the case of very longterm disability. We understand that timely, accurate issuance of benefits and notices is a core responsibility.
Late payments must include the self-imposed increase in accordance with the Labor Code. Reasons for the late payment shall be clearly documented in the claim file within one (1) business day.
We consider this to be a core responsibility. Although penalties are rare at LWP, we do self-impose 10% penalties whenever a payment is late. Additionally, we will provide the City with an action plan to communicate steps we will take to prevent any further occurrences.
18. Return to Work
The TPA shall provide assistance to CITY in coordinating return to work information that is appropriate for injured employees while recovering and prior to their return to regular duties.
LWP is committed to proactive disability management that is focused on early and sustained Returnto-Work. We recognize the need for early aggressive medical treatment so as to minimize disability and facilitate case resolution. We know that claims resolve quicker when the injured worker is returned to work. While an injured worker is disabled, we contact the treating physicians no less frequently than every two weeks. During the call, we attempt to coordinate release to full duty or, failing that, a return to modified or alternate work. Our staff is trained to probe for information about what an employee is physically ABLE to do, rather than accepting “unable to return to work” as a status. We focus on activities of daily living to determine whether we can work with the employer to create modified duties based on those abilities.
By calling the treating providers, we eliminate the wait for reports that can significantly slow the progress of return to work and claim closure.
The TPA shall consult with CITY at least once a month in those cases where the injury residuals might involve work restrictions and assist CITY in the provision of modified duty when appropriate.
Agreed
The TPA shall notify CITY immediately upon receipt of an employee’s permanent work restrictions so that CITY can determine the availability of permanent modified or alternative work. Notification shall clearly be documented in the computer notepad within one (1) business day.
Agreed
19. Transportation Expense/Self-Procured Expenses
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Transportation/Self-Procured Expenses reimbursement will be reviewed for accuracy, approved for payment, and paid within three (3) business days of the receipt of the claim for reimbursement.
Advance travel expense payments will be mailed to the injured employee/claimant at least ten (10) calendar days prior to the anticipated date of travel.
Agreed
20. Permanent Disability
At LWP, we believe that settlement negotiations begin with the three-point contact. Establishing rapport and trust during the initial communications sets the stage for a productive relationship that can result in fair and effective settlement negotiations.
We recognize that negotiating with integrity and communicating effectively with the injured worker can result in a mutually acceptable resolution. We further recognize that it is our responsibility to assist the injured worker throughout the life of their claim, including in finalizing the permanent disability aspect.
Because our litigation rates are low, and further because we recommend the use of defense attorneys only about 50% of the time in cases where injured worked is represented, we are very accustomed to negotiating directly with injured workers.
The TPA shall determine the nature and extent of permanent disability and arrange for an informal disability rating whenever possible to avoid Workers’ Compensation Appeals Board (WCAB) litigation. Determination of the level of permanent disability shall be clearly noted in the claim file within one (1) business day.
Although all of our Examiners are fully trained in Permanent Disability rating, we also utilize the services of independent rating firms in complex cases where we believe it is appropriate to obtain confirmation of our rating.
We understand that the settlement process can seem overwhelming, and commit to providing plentiful support to the injured employee to all the employee to feel comfortable enough to avoid any perceived need for legal representation.
We fully understand the importance of identifying and pursing all valid sources of apportionment and credit in order to reduce the City’s liability. All required notices will be provided as indicated by the Labor Code.
The TPA shall take advantage of any potential apportionment potential to prior claims, disabilities, and impairments. The TPA shall also advise CITY on the date of injury of potential credits and increases to permanent disability benefits should CITY accommodate permanent/alternative work for at least twelve (12) months.
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We view this as a core responsibility.
All permanent disability benefit notices shall be sent to the employee/claimant as required by the California Labor Code. Copies of benefit notices will be maintained in the applicable claim file with a copy to CITY.
All required notices will be provided as indicated by the Labor Code.
21. Supplemental Job Displacement Benefits (SJDB)
In accordance with all applicable California laws, the TPA shall advise the injured employee/claimant of his/her right to SJDB, provide appropriate SJDB, control SJDB costs, attempt to secure the prompt conclusion of SJDB, and provide notification to CITY should work restrictions require permanent or modified alternative accommodations.
Immediately upon learning that the medical provider has determined that the injured worker cannot return to regular duties, we will communicate the restrictions directly to the client so that the Employer can evaluate whether the Employee can be returned to work or if the Employer needs to engage in the interactive process. Once the process is completed and there is a determination as to whether there is permanent modified work that meets all the criteria, we will send the appropriate benefit notices to the Injured Worker and follow up to ensure that the City has completed their process as well.
22. Supervision
The TPA shall provide supervisory staff that will regularly review the work product of the examiners.
The Supervisor shall review all new claims within the first thirty (30) calendar days of receipt from any source. The supervisor shall review at least ten percent (10%) of the examiner’s caseload each month to ensure each examiner is following the performance standards outlined in contract.
Written verification of the ten percent (10%) requirement will be provided to CITY upon request. In addition, the supervisor shall conduct a regular quarterly review of all open indemnity claims with future reserves in excess of $100,000 and all problem or complex claims. Such reviews shall include directions, recommendations, and/or appropriate feedback and be labeled as “Supervisor Review” and clearly documented in the computer notepad within one (1) business day.
The Supervisor provides the first line of quality assurance. Our Supervisors measure and monitor performance extensively to ensure that guidelines are followed, and steps are not skipped. In addition to their training and mentoring role, supervisors intervene in the adjusting process and play a pivotal role in ensuring quality claims handling. We are able to ensure that the supervisor will review 25% of the examiners caseload monthly and conduct a comprehensive review of claims with reserves in excess of $50,000. In fact, since LWP claims supervisors review every claim at least every 90 days, they actually review 1/3 of each caseload each month.
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Managers and Supervisors do not carry caseloads. It is central to LWP’s handling philosophy that Managers and Supervisors dedicate their time to overseeing the adjusting process. The Supervisor’s principal responsibility is to evaluate the examiners’ claims handling and provide feedback to ensure that all actions are proactive, timely, accurate and cost effective.
In addition to ensuring that a Supervisor reviews all claims at least every 90 days, we require Supervisors to sign off on a number of adjusting steps before Examiners can proceed. Supervisors are required to review and approve the following actions prior to completion. (Those approvals will be visible to the client through electronic access.)
▪ New loss assignment and direction
▪ Compensability approval (Accept, Delay, Deny, within 14 days) ▪ 28-day oversight diary
▪ Acceptance approval (if originally delayed or denied) ▪ Reserve change approval (items over examiner’s designated authority) ▪ Settlement approval (items over examiner’s designated authority) ▪ Award computation sheet approval
▪ Penalty payments approval
▪ Regular oversight diaries at least every 90 days
▪ Approval of any Award Computation worksheet
▪ Approval of any Penalty Payment
▪ Review and Approval of detailed Closing Checklist prior to file closing The first step in the supervision process is the Supervisor’s assignment of the claim to the proper Examiner. That assignment also includes their written recommendations for initial handling.
The Supervisor next looks at the file at 28 days. All files receive an automated 28-day diary. This allows the Supervisor to assess the quality of the 3-point contact, identify any issues that may need further investigation and to provide direction to the examiner. A Supervisor’s input will be documented in the progress notes.
A supervisor will have an oversight diary for at least every 90 days, with shorter intervals for those claims that require more constant direction or follow up. Additionally, the Supervisor may set a separate diary to follow up on certain specific issues or to ensure their prior directions have been followed.
Supervisors are very involved in the handling throughout the life of the claim. They attend client claim reviews, complete targeted reviews to spot particular issues (i.e. large losses, etc.) and also must approve various adjusting steps, as listed above.
Additionally, no file can be closed without a Supervisor’s review to ensure that all benefits have been properly paid, all notices properly sent and all issues have been resolved.
Our supervisors utilize a number of metrics to track claims administration performance and insure that guidelines are followed and timeframes are met, including:
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▪ Diary results - We measure the number of back due diaries and the date range of un-worked diary. Diary performance is measured weekly for each Examiner as part of the Weekly Supervisor Report. Results are compared with established performance standards regarding timeliness expectations, backlog volume and date range. ▪ Mail results - We measure the number of un-worked mail items in an Examiner’s inbox and the date of the oldest un-worked mail. Performance is measured weekly for each Examiner as part of the Weekly Supervisor Report and results are tracked against established performance standards for date range of mail.
▪ Reserve timeliness and accuracy - Reports detailing claims with authorized payments awaiting reserves are run multiple times per week and identified reserve issues are documented on the Weekly Supervisor Report. A separate report addressing all new claims with no reserve assigned to the file is completed at least once a week and documented on the Weekly Supervisor Report.
▪ Monthly closure activity - We benchmark this weekly to ensure regular closure activity is occurring and to track against established monthly closure objectives. ▪ 3-point contact timeliness - Results are tabulated monthly and reviewed for compliance with established performance standards.
▪ New loss set up completion - A weekly report is presented to each Supervisor to track Team metrics are always available to our supervisors through the use of data dashboards to ensure they are able to provide the best possible support to examiners. An example of a supervisor dashboard follows.
Because supervisors are required to review all active claims at least every 90 days, 1/3 of all claims are reviewed each month.
The supervisor shall monitor the diary reviews by printing a report each month to identify any files that have fallen off the diary system.
Agreed
The supervisor must review all medical only claims open beyond ninety (90) calendar days from the date of entry by the TPA for potential closure or conversion to indemnity claim status. Medical only claims with $3,000 or more paid-to-date on any claim open beyond one hundred eighty (180) calendar days from date of entry shall be converted to indemnity status and an appropriate precautionary indemnity reserve placed on the claim.
Agreed
23. Report Requests
Written claim status reports requested by CITY, in addition to the regular ninety (90) calendar day status reports, shall be provided by the TPA to CITY within ten (10) business days or a timeframe 117
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agreed upon with CITY. Verbal status reports requested by CITY shall be provided by the TPA within two (2) business days and clearly noted in the computer notepad within one (1) business day.
LWP provides written and/or verbal status reports at any time. Before each claim review, written status reports are prepared and provided to the City in advance of the claim review meetings and ahead of any deadline set by the City.
24. Litigated Cases
Notice of applicant representation shall be clearly documented in the claim file and include allegations of injury. All assignments to defense counsel will be appropriate and done with CITY’s authorization and consent. Litigation direction shall remain with the claims examiner. The TPA shall prepare clear and concise litigation referrals to outside counsel outlining the issues of the claim and duties that will be handled by defense counsel, which shall not be clerical in nature. Defense counsel shall clearly outline a written plan to defend the litigated issues and provide a written initial analysis and periodic written updates timely. The TPA shall monitor the outside counsel’s progress. The TPA shall audit all defense counsel’s bills before payment is authorized.
We pride ourselves in our very low litigation rate. We believe, and have proven, that prompt and appropriate file handling reduces the number of claims that go into litigation. LWP does not automatically refer all litigated cases to defense counsel. A notice of representation from an injured worker does not trigger a referral. In fact, LWP is frequently successful in bringing claims by represented workers to conclusion without any involvement from defense counsel. Cases are referred to counsel only based on the complexity of the issues, and the need for professional services.
We expect to recommend very infrequent referrals to counsel but recognize that any referral will require your approval. Any recommendation for referral will be accompanied by our rationale for referral and our proposed strategy.
We believe that legal referrals should take place when it is determined that legal assistance is required in order to achieve the best outcome on the claim. Many assignments need only be task specific and, as such, when the requested task is completed defense counsel is to report on the completed task and outline additional recommendations for the adjuster to consider. Further attorney activity may only be completed upon the documented approval of the adjuster.
Common reasons for referral:
• Complete depositions
• Complex issues that require WCAB intervention
• Enforce utilization review determinations
• MPN disputes
• Subrogation matters
LWP attempts case resolution prior to referral and will consult with the City before referrals are made. 118
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In the absence of defense counsel, the TPA shall work closely with the applicant’s attorney in disposition of litigated cases. The TPA shall confirm the defendant is properly named on all legal documents.
LWP looks for active communication to occur between the client, assigned counsel and the examiner.
We require the assigned attorneys to complete reports at each stage of the case and when key developments occur. After the initial budget and recommendations are received, we do not require a standard 30-day report as the case and case activity should drive reporting. We do not want the client to be billed at regular intervals if no work has been completed. The client and Examiner are kept abreast of developments through the claim system and regular contacts with legal counsel and active diary management. LWP also routinely conducts litigation reviews.
All preparation for a trial shall involve CITY so that all material evidence and witnesses are utilized to obtain a favorable result for the defense.
Agreed
The TPA’s manager, supervisor, or claims examiner shall attend WCAB hearings and meetings with defense counsel as necessary and as requested to do so.
Agreed
25. Settlements
The TPA shall obtain CITY authorization on all settlements and/or stipulations. If the total incurred amount exceeds CITY’s retention with the excess carrier, the written settlement proposal shall also be directed to the excess carrier to provide authority in addition to CITY’s authority. The TPA or defense counsel shall forward settlement proposals to CITY and the excess carrier if applicable.
Whenever the opportunity for a settlement arises, (including for 0% PD settlements), LWP staff will prepare a settlement evaluation for you. The evaluation will include all relevant information including employment status, permanent disability ratings, estimates of future medical care and costs, an evaluation of all legal issues, the rationale supporting the request and the projected ultimate value of the claim along with a proposed settlement range. We will also present our recommendation for a settlement instrument (i.e. Compromise and Release, Stipulation, etc.) along with relevant Medicare considerations.
Upon contract award, we would like to understand the City’s perspective relative to Compromise & Release settlements. We have found that for clients who prefer Compromise and Release settlements, that even in situations where the future medical cannot be immediately settled (i.e. injured worker is not interested, or Medicare Set-Aside is exorbitant), there can be some cases where we may recommend a Compromise and Release with open medical treatment. In certain cases, this can serve the advantage of precluding claims for new and further disability and can leave the door open for a subsequent Compromise and Release of future medical care at a future date. 119
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Except in extraordinary circumstances, LWP provides a settlement analysis at least ten (10) days prior to any settlement offers or conferences.
All requests for settlement authority shall be clear and concise and include a written claim analysis, estimate of permanent disability, coverage, and the defense counsel’s comments and recommendations along with the dates of any pending litigation activity or conferences at the WCAB. If multiple claims are included in a settlement, the request shall outline the amount to be paid for each applicable benefit type to be paid on each claim.
Agreed
Settlement considerations must include an evaluation of the need for a Medicare Set Aside (MSA).
Any referral for an MSA evaluation must have the prior approval of CITY.
Agreed
26. Award Payment
Payments on Awards, computations, commutations, or Compromise and Release agreements will be issued within ten (10) calendar days, following receipt of the CITY’s authorization. Payments will be made sooner if necessary to ensure payments are made within twenty (20) calendar days of the WCAB approval date. Late payments must include the self-imposed increase and appropriate interest in accordance with the Labor Code.
Once approved, award and settlement payments are issued within 10 days.
The TPA shall document the claim file with the date of WCAB approval, the amount of the settlement, and the type and duration of future medical care recommended by the applicable medical provider. The TPA shall also document the reason(s) for any late payment of the Award.
Agreed
27. Subrogation
The TPA shall promptly initiate investigation of issues identified as material to potential litigation and subrogation recovery. In all cases where a third party is responsible for the injury to the employee/claimant, the TPA shall send a letter to the entity indicating they will pursue subrogation unless instructed otherwise by CITY. If the injured worker brings a civil action against the party responsible for the injury, the TPA shall consult with CITY about the value of the subrogation claim and other considerations.
Regular training is provided to claims staff to reinforce the types of claims and circumstances that are likely to have subrogation potential such as premises (i.e. slip-and-fall injuries), auto accidents and equipment malfunctions. Additionally, our proprietary claims system includes a checklist of potential subrogation triggers to prompt the Examiner to further investigate subrogation potential. 120
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At time of investigation, the Examiner documents the investigation and subrogation potential in the claims system. Those notes are available for viewing through on-line access, and are also included in our Plan of Action report. LWP will consult with the City potential subrogation cases to ensure that we have a proper understanding of relationships so that we can aggressively pursue subrogation when appropriate, but do not interfere with any of the City's relationships inadvertently.
We present our evaluation of the cost/benefit of pursuit for the City’s consideration. We will then continue to update our cost/benefit analysis as facts change. You will be involved every step of the way.
Responsible parties will be put on notice within 10 business days of a determination, with an appropriate claim filed within six months. All related information will be documented in the notepad and available for review by the City at any time.
When subrogation is to be pursued, the third party shall be contacted within ten (10) business days with notification of CITY’s right to subrogation and the recovery of certain claim expenses.
If the third party is a governmental entity, a claim shall be filed with the governing entity within six (6) months of the injury or notice of injury.
Periodic contact shall be made with the responsible third party and/or insurer to provide notification of the amount of the estimated recovery.
Our Claims Examiners make regular contact with responsible parties. All recovery activities are documented in our notepad and will be available to the City through on-line access, and are also included in our Plan of Action reports. LWP’s reports will outline the estimated recovery amount and all factors impacting likely recovery.
Subrogation rights will not be waived without written consent from CITY and CITY’s excess carrier.
Upon CITY’s authorization, subrogation counsel shall be assigned to file a Lien or a Complaint in Intervention in the civil action within the applicable Statute of Limitations.
LWP consults with the City on all subrogation cases to ensure that we have a proper understanding of relationships so that we can aggressively pursue subrogation when appropriate, but do not interfere with any of the City's relationships.
We will present our evaluation of the cost/benefit of pursuit for the City’s consideration. We will then continue to update our cost/benefit analysis as facts change. You will be involved every step of the way.
Whenever practical, the TPA should take advantage of any settlement in a civil action by attempting to settle the workers’ compensation claim by means of a Third-Party Compromise and Release. Refer to Item 21 regarding the consideration of MSA settlements. If such attempt does not succeed, then
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every effort should be made through the WCAB to offset claim expenses through a credit against the proceeds from the employee/claimant’s civil action.
LWP makes every effort to obtain a Third-Party Compromise and Release for our clients. When not possible, we will assert our client’s credit rights and work to both recover prior payments to the extent possible, while also obtaining credit against future payments.
The TPA shall be responsible for collecting subrogation recoveries from the appropriate third party on a quarterly basis. A copy of the request to the third party shall be forwarded to CITY until such time as the TPA is instructed otherwise. Any discrepancy in the recovery or reimbursement amount shall be clarified in the claim notes at the time of each request for reimbursement. Settlement negotiations will include involvement of CITY and CITY’s Excess Carrier if appropriate.
Agreed
28. Fraudulent Claims
Any claim with suspected fraudulent activity shall be referred to the TPA’s special investigation process for further investigation and potential referral to the appropriate authorities. The claim will be referred to an investigator with CITY’s prior approval, to conduct further investigation. CITY will be notified of the referral and be provided with periodic updates.
At LWP, a prompt and thorough investigation answers the questions of “who, what, when, where, why and how.” A prompt inquiry to determine the facts while the events are still fresh in everyone’s mind promotes the Claims Examiner’s ability to control and coordinate management of the claim.
We recognize that claim investigation is critical to determining issues of employment, compensability, benefits, subrogation and safety hazards or violations. Claim investigation begins with the 3-point contact process. During the initial claim investigation, information may be uncovered that raises further questions and the need for a more extensive investigation. When these situations arise, the Examiner may recommend the use of an outside investigation, depending on the facts of the case.
We continue to work closely with the City to determine those cases that may benefit from outside investigations. Any potential referrals are reviewed with the City prior to assignment. LWP has a close working relationship with Dayta Group, which we can recommend highly. They will recommend a particular investigation firm for each assignment, based on their extensive knowledge of the various firms and their expertise and specialties.
Separate from any indications from you that would trigger a potential referral for surveillance; we believe that there are a number of criteria that can be indicators that a field investigation and faceto-face statement taken from the injured worker may be indicated. Those criteria include:
▪ Employee’s account of incident changes as it is retold ▪ Employee claims to have “forgotten” to report an important mechanism of injury ▪ Employee’s initial account differs from physician’s First Report of Injury 122
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▪ Employee fails to report the injury in a timely manner ▪ Lack of physical evidence to support claims
▪ Alleged injuries appear to be physically impossible
▪ Mechanism of injury is inconsistent with alleged injuries ▪ More suspect if incident reported after days off
▪ Monday morning report of a Friday injury
▪ Claim filed more than a few days after the alleged injury ▪ Claim occurs in conjunction with layoffs or announcements of changes ▪ Claims occurring after termination
▪ Multiple prior claims
▪ Frequent address or phone changes
▪ Using a PO Box as a home address
▪ Worker uses addresses of friends, family, or PO Boxes; has no known permanent address and moves frequently.
▪ Inability to contact claimant at home when totally disabled ▪ New hire at employer
▪ Chooses treating physician that is significant distance from employee ▪ Tries to treat outside the MPN
▪ Upcoming job change or seasonal layoff immanent
▪ Worker reports an alleged injury immediately following disciplinary action, notice of probation, demotion, or being passed over for promotion ▪ Worker has known high-risk activity, such as mountain climbing or snowboarding ▪ Worker avoids the use of U.S. Mail; hand-delivers documents ▪ Employee is known to have simultaneous employment
We expect to discuss investigation activity at each claim review and stewardship meeting.
29. Future Medical Claims
Claims that remain open to monitor future medical care shall remain open for two (2) years from the last provision of any benefit in accordance with Labor Code 3207.
At LWP, we do not “process” future medical claims—we “adjust” them. We review requests for medical treatment very carefully, considering medical necessity, consistency with the award (body part, type of treatment awarded, etc.) and possibility of new injuries. We work closely with excess carriers, and also look for opportunities to reduce the need for ongoing medical care, including weaning injured workers from long-term medication use.
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Throughout the life of the Future Medical claim, we continue to do the following:
• Review the Award – to insure there has been no “creep” in the future medical treatment. We remain vigilant that no additional body parts or medications or treatment protocols are requested that are not consistent with the awarded treatment. • Review the P&S report on which the Award was based – This insures that any of our team members who review the claim accurately interpret the Awarded treatment. • Consider wean-down treatment to reduce dependency on pain medications – Overutilization of expensive medications is often the barrier to a cost-effective settlement of future medical cases. Acknowledging that this can be a very difficult challenge, we have had some success in reducing the dependence on medications substantially enough to posture a case for a costeffective settlement.
Compromise and Release settlements are considered at every juncture. Should the case require a Medicare Set Aside, we would consult with City to determine if it makes sense to consider a settlement. We believe that it is generally possible to predict the Medicare Set Aside values (at least a ballpark value) which can give City an indication as to whether there may be any interest in a settlement. If it is likely that the MSA would result in a prohibitively expensive settlement, we always recommend against pursuing the MSA.
We review reserves at every touch, and do a thorough reserve review at least annually, recalculating the three-year average and considering any changes in treatment patterns and/or other new information.
This review is clearly documented in the notepad and the rationale for any changes is further documented on the Reserve Worksheet. Both create permanent records in the claim file and are available for the Client to review electronically at any time.
Claims that are not settled will remain open for 2 years from the provision of last benefits in accordance with Labor Code 3207.
Reviews of the file shall be documented in the claim notes to include settlement information, future medical care outline, last date and type of treatment, name of excess carrier, excess carrier reporting level, and excess carrier reporting history.
Agreed
Reserves for future medical treatment will be reviewed every one-hundred eighty (180) calendar days and adjusted for use over a three (3) year average and the injured employee/claimant’s life expectancy based on the most recent version of the U.S. Life Table. The reason(s) and calculation(s) for the adjustment(s) shall be clearly documented in the claim file within one (1) business day.
Agreed
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The TPA shall evaluate the claim at least annually to determine a reasonable amount for settlement of future medical benefits and any remaining benefits due. The reason(s) and calculation(s) for the recommended settlement amount shall be clearly documented in the computer notepad within one (1) business day. The TPA shall clearly document the claim file with the outcome of the settlement negotiations with the employee/claimant and/or applicant’s attorney. Refer to Item 25 regarding the consideration of MSA settlements.
Agreed
Should active litigation develop after the claim has been settled, the claim will be considered active and will no longer be considered a future medical claim. All appropriate performance standards contained in this document pertaining to active claims will apply.
Agreed
30. Excess Coverage
Cases that have the potential to exceed CITY’s self-insured retention shall be reported in accordance with the reporting criteria established by the excess coverage policies. All cases that meet the established reporting criteria are to be reported within ten (10) business days of the day on which it is known the criteria is met, or sooner if required by the excess carrier. The report shall be on a form satisfactory to the excess carrier and submitted electronically ninety (90) calendar days from the date of the initial notice and every ninety (90) calendar days thereafter, unless indicated otherwise by the excess carrier. Each submission shall include the supporting documents required by the excess carrier.
We view this as a core responsibility and commit to complying with all excess reporting requirements.
We are very familiar with LAWCX’s reporting requirements and are confident we can support the City’s reporting and reimbursement protocols. We are pleased that our last audit by LAWCX (conducted January 2023) resulted in a score of 99.4%.
A copy of the submission to the excess carrier and subsequent reports shall be forwarded electronically to CITY until such time as the TPA is instructed otherwise.
City will continue to be copied on all reports and reimbursement requests sent to your excess carriers.
31. Excess Reimbursements/Recoveries
The TPA shall be responsible for collecting reimbursements and recoveries from the excess carrier and on a quarterly basis. Reimbursements shall be requested by the twentieth (20th) of the following month after the quarter ending March 31, June 30, September 30, and December 31. If the claim remains open to monitor future medical care, reimbursements shall be immediately requested when the claim is reviewed semi-annually.
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LWP complies with the requirements of client and their excess carrier(s). For each client, we create Special Claims Handling Guidelines that detail the specific requirements for that client. Those guidelines will be followed, with reports to excess carriers being completed according to the thresholds and timelines set by the carrier.
A copy of the request to the excess carrier shall be forwarded to CITY until such time as the TPA is instructed otherwise. Any discrepancy in the recovery or reimbursement amount shall be clarified in the claim notes at the time of each request for reimbursement.
LWP also carefully tracks excess reimbursements and can provide a recap to the client at any time.
32. Overpayments
The TPA shall be responsible for collecting any overpayment of any benefit. In the event that the TPA fails to collect the overpayment, the TPA may be responsible to reimburse CITY for the amount of the overpayment. Any settlement which considers credit for an overpayment against “new and further” disability must be reviewed and approved by CITY. The claim notes shall outline the reason and amount of the overpayment and the efforts taken to request reimbursement for the overpayment.
Agreed
33. Penalties/Self-Imposed Increases
Late payment of all benefits must include the self-imposed penalty/increase in accordance with California law. The claim notes shall outline the reason and amount of the penalties/increases.
LWP is very mindful of statutory and administrative requirements and incurs very few penalties. In cases where a penalty is due, LWP will immediately reimburse the City. We will provide the City with an action plan to document our plans to prevent any future occurrences.
The TPA shall adhere to the requirements outlined in Section 25, Settlements, when settling exposures for penalties/increases.
Agreed
34. Case Closure
Every attempt should be made to conclude cases as fairly and expeditiously as possible to avoid unnecessary litigation.
Medical-only claims open beyond 60 days from the date of entry by the claims examiner shall be reviewed for closure or potential conversion to indemnity claim status. 126
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Claims with $3,000 for more paid to date and/or open beyond 180 days from the date of entry shall be converted to indemnity status and a reasonable, precautionary indemnity reserved placed on the claim.
All indemnity cases, where permanent disability is not an issue, will be closed within sixty (60) calendar days of the final financial transaction or final correspondence to the employee/claimant as required by law.
All indemnity claims where permanent disability is an issue will remain open for two (2) years from the last payment of any benefit and then closed within sixty (60) calendar days of that date.
All indemnity claims where permanent disability has been denied will be closed withing 30 days of denial.
These requirements are consistent with our best practices and are followed.
35. Compliance with Labor Code
The TPA shall comply with all provisions of the Labor Code and Rules and Regulations.
At LWP we consider compliance with all provisions of the Labor Code to be a core responsibility.
36. Performance Expectations
Performance Standards shall be reviewed and implemented by all TPA staff assigned to CITY’s Program within thirty (30) calendar days of approval of an agreement and/or staff assignments.
At time of renewal, we would welcome the opportunity to refresh any aspects of our services that are of interest.
Verification of compliance shall be made available upon request by CITY.
Agreed
37. Financial Administration
CITY has established a trust account from which the TPA shall make all indemnity, medical, and allocated loss expense payments. Payment authorization limits and payment policies will be established by CITY and reviewed from time to time with the TPA. The TPA’s monthly service fee shall not be paid from the trust account.
As the incumbent, banking arrangements are already in place, alleviating the need to utilize the City’s resources to setting up these processes.
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Having said that, we are also happy to revisit the trust accounting procedures, if there are any aspects of the process that can be made easier for the City to manage.
At LWP we believe that our clients should have control over banking relationships. While we have many different methods of calculating advance funding a standard would be to fund a trust account with 6 weeks average payments and then replenish once a month within about a two week window to allow for consistent movement of payments.
LWP has a dedicated banking team that is always available to the City. The team can provide any reporting needed, both scheduled and ad hoc. We regularly reconcile accounts (by the 15th of each month, unless required earlier by a client), analyze the funding adequacy, provide historical reporting as well as recommendations and support. The City can modify your banking arrangements at any time.
We routinely provide check stock, manage replenishments, build and manage two-way positive pay feeds to various banks, and provide all accounting and reconciliations. We can provide both standard and customized reports to meet the City’s accounting needs.
LWP takes very seriously our responsibly for financial integrity. Among the many actions we take to ensure quality and fiscal integrity are:
▪ Reconciliation of accounts every month
▪ Implementation of positive pay for client checking accounts ▪ Careful separation of duties to limit the opportunity for fraud ▪ Automated duplicate checks on payments even on bills that have been through bill review ▪ Supervisory oversight of reserving including automated safeguards on the amount of reserve changes including client involvement on large transactions ▪ Adjuster approval of all bills prior to payment or bill review with extensive audit trails ▪ Extensive management reports on system access, roles, and authorities ▪ Automated data integrity checks in both medical and straight pay ▪ Double-blind keying of straight pay bills
▪ Payment checks on medical bills
▪ Vendor W-9 setup by two individuals with no ability to make payments ▪ Validation of tax ids against the IRS database
▪ All client data feeds are cross checked against loss runs at specified time intervals TPA service fees are never paid from the trust account, but rather are invoiced directly to the City separately.
The TPA shall maintain complete and accurate records with respect to costs, expenses, receipts, and other such information required by CITY that relate to the performance of services under this RFP.
The TPA shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible.
All financial records related to individual claims are contained in the Origami claims system, which is available for inspection via your online access at any time. 128
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LWP will make any and all non-claims-specific records available for the City’s review upon request.
38. Right to Audit
CITY or its designated representative is authorized to visit the TPA’s processing and/or storage premises for the purpose of performing a claims audit, and shall have access to all data, including paper documents, microfilm, microfiche, and magnetically stored data which relate to payments or non-payments made by the TPA. Any assistance or service provided in response to a claims audit described above will be rendered at no additional cost to CITY.
The City is welcome to audit our work, at any time, with or without notice. We are happy to host auditors in our office but can also accommodate auditors electronically. We do not maintain any paper files. Everything can be accessed through online access to the claims system, which we are happy to provide to the City, LAWCX and your designees.
39. Payments Outside of Coverage Period
No charges to CITY for payments made on behalf of persons who were not valid employees of the covered CITY on the date of injury shall be accepted for payment by CITY. The TPA may be responsible to reimburse CITY for any amounts paid in error.
Agreed
40. Personnel
The TPA agrees to assign only competent personnel who have been with the TPA for a minimum of one (1) year according to the reasonable and customary standards of training and experience in the relevant field to perform services pursuant to an agreement. Failure to assign such competent personnel shall constitute grounds for termination of an agreement. The TPA also agrees to assign an examiner who will remain handling CITY’s claims for at least a one (1) year period.
Our goal at LWP is to be a great place for great professionals to work. We have no tolerance for mediocrity and make no attempts to be a nice place for average performers to work. It is our philosophy to always hold ourselves to higher standards that those to which our clients hold us. We measure and monitor performance extensively and have a rigorous performance management system. We use Key Performance Indicator reports; weekly and daily tracking reports and several builtin systems monitors to ensure that we meet and exceed performance expectations. Additionally, we undergo frequent audits by carriers (primary and excess), reinsurers and the State. We dissect every audit to learn what we can do to further strengthen our work product, no matter how positive the auditor may view the results.
Our supervisors utilize a number of metrics to track claims administration performance and ensure that guidelines are followed and timeframes are met, including:
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▪ Diary results - We measure the number of back due diaries and the date range of un-worked diary. Diary performance is measured weekly for each Examiner as part of the Weekly Supervisor Report. Results are compared with established performance standards regarding timeliness expectations, backlog volume and date range. ▪ Mail results - We measure the number of un-worked mail items in an Examiner’s inbox and the date of the oldest un-worked mail. Performance is measured weekly for each Examiner as part of the Weekly Supervisor Report and results are tracked against established performance standards for date range of mail.
▪ Reserve timeliness and accuracy - Reports detailing claims with authorized payments awaiting reserves are run multiple times per week and identified reserve issues are documented on the Weekly Supervisor Report. A separate report addressing all new claims with no reserve assigned to the file is completed at least once a week and documented on the Weekly Supervisor Report.
▪ Monthly closure activity - We benchmark this weekly to ensure regular closure activity is occurring and to track against established monthly closure objectives. ▪ 3-point contact timeliness - Results are tabulated monthly and reviewed for compliance with established performance standards.
▪ New loss set up completion- a weekly report is presented to each Supervisor to track It is our philosophy that the client should not suffer for any performance issues that are identified.
While we work with the Examiner to successfully improve performance, the Supervisor will step in to assure that the work does not suffer, and that the benchmarks are met.
We welcome your feedback into the effectiveness of our team’s performance at any time.
CITY’s examiner shall have passed the State of California, Department of Industrial Relations, SelfInsurance Administrator’s Examination. The TPA shall annually certify to CITY that the claims examiner handling CITY’ claims is in compliance with all legal and regulatory licensing and continuing educational requirements as presently or in the future shall be promulgated and required by the State of California. It is understood that CITY has the right to require the TPA’s staff to be removed from their program based on unsatisfactory performance.
At LWP, we know that we are only as strong as our weakest colleague. Therefore, we work diligently to ensure all staff are fully qualified, meet performance expectations and make our team stronger by their participation. We understand that certification is a minimum requirement and intend to assign only certified (both as a California Adjuster and as a certified adjuster for California Self-Insurance.) We offer our criteria for staff, and also certify that the team assigned to the City meets these criteria.
Our criteria for selecting candidates for Supervisor and Examiners are:
The Claims Supervisor oversees the work of the Examiners. These team members will perform oversight diary and will review and approve delays, denials, acceptances after delay, settlements, 130
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referrals to counsel, investigators, Utilization Review, etc. Staffing will be determined in collaboration with the City. When hiring for the team, we will look for the following:
▪ Minimum of 10 years Claims Experience
▪ Minimum 2 years Supervisory Experience
▪ Licensed Self-Insured Administrator
▪ State Certified Examiner Status
▪ Receptivity to the client’s program needs
▪ Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
▪ Candidate must successfully pass LWP’s background checks (credit and criminal) The Examiner adjuststhe Indemnity claims under the supervision of the Claims Supervisor. Authorities will be set at the lower of the City’ and LWP’s guidelines and our joint assessment of each person’s performance. When assigning Examiners for you, our standards will be:
▪ Minimum of 5 years Adjusting Experience
▪ Minimum 2 years’ experience managing claims for Municipalities ▪ Licensed Self-Insured Administrator
▪ State Certified Examiner Status
▪ Receptivity to the client’s program needs
▪ Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
▪ Candidate must successfully pass LWP’s background checks (credit and criminal) We are always happy to discuss the performance of any member of our team, including their qualifications and “fit” for the City’s program.
The TPA shall require an examiner to be available and to readily respond to CITY’s request for assistance with problem cases, which may include in-person visits with CITY.
We will ensure that one or more Examiners are always available to the City. Our buddy system ensures that any alternative work schedules are staggered so that there is always ample coverage. Additionally, we provide cell numbers for our managers and officers as well as an 800 number.
The TPA shall require its examiners or other TPA personnel, as necessary, to attend CITY’s regularly scheduled Board of Directors and Executive Committee meetings to report on the general state of the program since the last meeting, and on any particular cases of interest to the Board and Executive Committee.
We are happy to provide the reports, and are also happy to appear at Board of Directors’ meetings to actually present the findings, if that is preferred.
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The TPA shall ensure that other personnel, such as management, clerical, accounting, and data processing, which may be required to satisfactorily provide the services required by an agreement, shall be provided by the TPA within the agreed fee for services contained in this RFP. It is understood that the personnel referred to in this paragraph need not be dedicated to the exclusive use of CITY.
In addition to the dedicated team, LWP has a Centralized Services team that supports all our clients.
That team is responsible for opening and scanning mail, entering straight-pay payments that have been approved by the Examiners, client banking and accounting, client support for online system, “policy” input, new claim input and internal audit.
This team, as well as all LWP management staff, are available to the City at any time, even while serving other LWP clients.
41. Client Services
The TPA shall provide special, in-person training services annually to CITY to ensure that CITY’s staff that process workers’ compensation claims are effectively carrying out the procedures required for a successful program.
LWP offers our clients customized Workers’ Compensation training. We will develop modules to meet specific requests. For several clients, we conduct regular sessions, while for others, we respond to very specific individual requests.
Additionally, we regularly route updates to our clients, as well as developing PowerPoint presentations and conducting webinars for our clients. We can commit to keep the City’s risk management staff up to date on legal and case management trends via regular communications.
The TPA shall consult annually with CITY on the establishment and coordination of necessary procedures and practices to meet the needs of CITY with respect to the administration and processing of claims.
We believe that all our procedures and practices should evolve continually as new practices, tools and procedures become available, and as the needs of the City change and evolve. We are happy to meet annually to review these, but also believe that changes can/should happen at any time, when the opportunity and need arise.
The TPA shall provide CITY with information regarding statutes, proposed changes to statutes, and changes to the rules and regulations affecting CITY and its responsibility as a legally uninsured workers’ compensation authority.
If there is a law or regulation change that immediately impacts the City, we will ensure that the City is provided with the necessary information and recommendations to facilitate the change. Further, it is anticipated that trends and changes in the workers’ compensation system will be discussed in the claim review process. From time to time, we recommend that assigned defense counsel attend claim 132
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reviews so that they can not only assist in facilitating proper case management and closure, but to bring the parties up to date on any legal reforms.
42. Computer Access
The TPA shall provide online access at no additional charge to CITY. Such data shall be in a format accessible from CITY’s computers and will permit CITY to print copies of the data on its printers. The TPA shall provide CITY with training for use of their computer system. If CITY, under the TPA’s guidance, is not able to maintain online interface with data maintained by the TPA, the TPA may be required to provide a copy of all data processed during the previous month to CITY;s office on a disk by the tenth (10th) calendar day following month end.
The TPA shall also provide online access to the excess carrier and their vendors as requested.
LWP provides the City with access to the Origami system, allowing the client to do the following:
▪ Report claims to LWP online
▪ View a customized dashboard with metrics relevant to the client ▪ View individual claims details (including financials and adjuster notes) ▪ Run reports
Although we provide very robust online access, we do not expect the client’s needs to be met via selfservice. We offer these self-service tools but fully expect to provide all reports and data that is requested by the City.
43. Confidentiality of Information
All data, documents, or other information developed or received, verbally or in writing, in performance of the agreement between the TPA and CITY are confidential and not to be disclosed to any person except as authorized by CITY, the TPA, or as required by law.
The confidentiality of all information will continue to be protected by LWP in all circumstances.
44. Protection of Data
It is the TPA’s responsibility to develop and implement processes and procedures relating to the protection of CITY’s electronic data, including a suitable security and back-up system for all stored data and a written policy with respect to disaster recovery, physical and electronic data security, and electronic data retention, as per the standards for Accreditation with Excellence by the California Association of Joint Powers Authorities (CAJPA).
LWP takes data security very seriously. We commit to continuing to meet all the City’s requirements, as well as the ongoing requirements of CAJPA certification, for which we have a number of certified clients.
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In choosing Origami Risk, LWP has chosen a platform with the highest level of focus on Security. We offer their security statements in their own words:
Application Security
With a web application such as Origami Risk, there are a number of fronts that must be managed in order to help ensure that data is secure. One of the major focuses for Origami Risk is within the application itself. Origami Risk takes a number of steps to help ensure application security, including:
▪ Penetration Testing – Origami Risk conducts regular testing to help ensure that the defenses employed in the application and environment are sufficiently keeping up with vulnerabilities that could be exploited to compromise our clients’ data. ▪ Vulnerability Assessment – Origami Risk uses state-of-the-art tools to regularly perform scans for vulnerabilities within its information system and client applications. ▪ User Security – Origami Risk’s role-based security provides clients the ability to manage their users’ access and capabilities down to the field level. In addition, Origami Risk is built to accommodate Single Sign-On authentication, allowing clients to authenticate their users to specific roles through their own network.
▪ Encryption helps ensure that Origami Risk’s client data is protected from unauthorized access at all times. All data is encrypted in transit and at rest within Origami’s Amazon Web Services Elastic Cloud environment and all Origami Risk databases use file-level encryption. In addition, all web traffic is encrypted using Transport Layer Security (TLS). ▪ Intrusion Detection and Prevention tools are also utilized to establish a security perimeter that provides Origami Risk with real-time alerts of suspicious activities and traffic that are indications of an active or attempted compromise.
Data Center Security
Origami Risk’s servers are housed in the Amazon Web Services Elastic Cloud environment. Amazon Web Services Elastic Cloud maintains several data centers with the highest standards in data security.
Amazon Web Services Elastic Cloud data centers are housed in nondescript facilities that have extensive setback and military grade perimeter control berms, as well as other natural boundary protection. Physical access is strictly controlled both at the perimeter and at building ingress points by professional security standards utilizing video surveillance, state-of-the-art intrusion detection systems, and other electronic means. Authorized personnel must pass two-factor authentication no fewer than three times to access data center floors. All visitors and contractors are required to present identification and are signed in and continually escorted by authorized staff.
Amazon also provides environmental controls in its data centers to assure the proper working condition of its systems, including fire prevention/suppression, power management, and temperature controls.
Origami Risk utilizes Amazon regions that are confined to the United States. Data maintained by Origami Risk is kept in these regions and will not be moved to offshore regions. 134
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Compliance
Origami Risk maintains compliance with the following standards, attesting to our commitment to provide world-class security:
a. SOC 2 is a reporting framework created by the American Institute of Certified Public Accountants (AICPA) that assesses the controls of service companies such as Origami Risk.
Origami Risk’s SOC 2 report, prepared pursuant to an independent third-party examination, demonstrates how Origami Risk achieves compliance with important controls related to security and confidentiality. Origami Risk’s SOC 2 report contains a description of its controls environment and an external audit of its controls that meet the AICPA Trust Services Security and Confidentiality Principles and Criteria. Origami Risk’s service is audited under this framework on an annual basis by an accredited firm.
b. FISMA – Origami Risk is compliant with security controls based on NIST 800-53 Revision 4 and has received Federal Information Security Management Act (FISMA) Moderate System Authorization and Accreditation. In addition, the Origami Risk service has received Authorization to Operate (ATO) by a federal authorizing agency. c. HIPAA Security Rule – Compliance with NIST 800-53 allows Origami Risk, by way of existing security controls, to meet security requirements established by the HIPAA Security Rule in accordance with NIST SP800-66, “An Introductory Resource Guide for Implementing the HIPAA Security Rule”.
d. EU-U.S. and Swiss-U.S. Privacy Shield – Privacy Shield is a framework designed by the U.S.
Department of Commerce and European Union member countries and Switzerland to provide companies with a mechanism to comply with EU and Swiss data protection requirements when transferring personal data from the European Union and Switzerland to the United States. Origami Risk has joined the Privacy Shield Framework and has self-certified to the U.S.
Department of Commerce that it agrees to adhere to the Privacy Shield Principles. Evidence of this certification is available at https://www.privacyshield.gov/. e. EU General Data Protection Regulation (GDPR) – The GDPR is a comprehensive data protection law in the European Union (EU) that will become effective on May 25, 2018. Origami Risk is committed to GDPR compliance when enforcement begins and is dedicated to helping customers comply with the GDPR with regard to the Origami Risk service, which includes providing GDPR-related assurances in Origami Risk’s contractual commitments. Additionally, Amazon Web Services (AWS) – the cloud computing environment for Origami Risk – has announced that it will comply with the GDPR when the regulation becomes enforceable.” In addition to Origami’s security measures, LWP takes many actions to prevent data breaches and maintain information security. Among these are:
▪ Maintaining secure, separate sub-nets via our firewalls that restrict of who can access our systems as part of our perimeter defense against data breaches ▪ Intrusion detection
▪ Anti - virus and malware software on all machines
▪ Laptop access is restricted to company officers and those individuals authorized by CEO ▪ Removal of all SSN’s from standard and ad-hoc reports 135
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▪ Encryption of all data feeds and transmittal via a secure mode (typically sFtp) ▪ Enforcement of password complexity and change policies ▪ Restrictions on who can set up accounts and requirements about documentation of approval for access and authorization
▪ Encryption of claims data and documents in storage
▪ All servers are maintained at a secure Teleco Data Center ▪ Access to the Data Center is limited to 4 pre-screened individuals ▪ Restrictions on software that can be loaded on corporate machines ▪ Periodic audit of access and access attempts
▪ Periodic penetration testing
45. Computer Generated Reports/Loss Runs
LWP maintains very robust reporting capabilities. We deliver reports via several methods:
▪ Regularly scheduled reports are emailed to clients
▪ Client access to run reports using multiple templates ▪ Client access to ad hoc reporting
▪ Customized reports prepared by LWP staff
▪ Stewardship reports
Scheduled Reports - Upon contract award, LWP will meet with the City to determine the reports that you would like to receive on a regular basis. These reports will be delivered to you on your specified schedule. The menu of reports available includes:
▪ Cumulative Loss Runs (can be provided at any organizational level) ▪ Fiscal Period Report (including detailed financial transactions, reserves, payments and recoveries) during a stated period of time. It can be run with detail, or summarized ▪ Closed Claim Log
▪ Claims logs of various claim identifiers (ie. First Aid, Litigation, Back Claims, etc.) ▪ Standard Claims Summary (financial and data summary of each claim) ▪ Payment type reports
▪ Loss Triangle Reports (incurred, paid, outstanding)
▪ 4850 Reports
▪ Injury Type Reports (Cause, Site, Nature of Injury, Occupation) ▪ Lag Time Reporting (date of loss/date report)
▪ Losses reported by tenure with Company
▪ OSHA 300 and 300A
▪ Check Registers
▪ Individual Claim Reports (Notes, reserve activity, plan of action, etc.) 136
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Standard reports templates allow user to specify:
▪ Filters (i.e. open vs. closed, claim type, date opened, date closed, etc.) ▪ Organizational and timeframes - (i.e. reports can be run by division and/or department, and for any fiscal period)
▪ “Value as of” capability
Ad-Hoc Reporting: The City can also have access to Origami’s Ad Hoc reporting tool, which allows for real ad hoc creation of spreadsheets containing any of more than 100 data elements. Spreadsheets can be sorted, formatted and manipulated to allow maximum access to their data. Data from the prior administrator will be made available through this tool (subject to the quality and availability of that data). All reports are exported to Excel spreadsheets. Reports can be stored and edited for re-use. All data in the report can be as of a user specified value-as-of date or current to that instant in time.
Customized reports prepared by LWP staff: LWP maintains staff with expertise in creating customized reports. The City has unlimited access to our staff and can request ad-hoc or customized reports at any time. We employ a full-time analyst with very advanced capabilities in order to assist clients with advanced reporting and analysis needs.
Stewardship Report: LWP offers both standardized and customized stewardship reporting in both data and graphical format. At renewal, we would like to discuss the City’s current use of our reports and offer to revamp our reporting to the City to meet your current needs.
All reports are included in the admin fee. Sample reports at attached as Addendum C.
The TPA shall, at its expense, by the tenth (10th) calendar day of the following month, unless otherwise specified below:
A. Electronically provide the following information monthly to CITY, as it pertains to their respective claims:
i. A listing of all open claims showing the employee/claimant’s name, claim number, date of injury, paid amount, future liability, total incurred, and any amounts recovered; Agreed
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