DuLuolyn CiveIupe ID.  MarionCounty ORICON FINANCE DEPARTMENT Contact: Vanessa Keck Phone #: (503)566-3910  Contract Review Sheet Contract for Services #: BS-6117-24  Amendment #:  Department: Business Services Department Analyst: Kathleen George  Title: Self-Funded Workers Compensation Program Contractor's Name: Cannon Cochran Management Services, Inc.  Term - Date From: July1,2024 Original Contract Amount: $ Current Amendment: $ Incoming Funds  Expires: June 30, 2029 Previous Amendments Amount:  175,201.48  $ Amd%  New Contract Total: $ Reinstatement  175,201.48  0% Department  Federal Funds  Retroactive  Amendment greater than 25%  Source Selection Method: 50-0110 Insurance Contracts  Description of Services or Grant Award  Claims Management and. Administration for the self-insurance program. Contractor shall manage and administer all claims ofthe County that occur. All claim payments shall be made with County funds. Contractor will act on behalfoft the County  in handling, monitoring, investigating, overseeing and adjusting all actual and alleged claims.  Desired BOC Session Date: Agenda Planning Date Management Update BOC Session Presenter(s) Comments: Y  6/26/2024 6/13/2024 6/11/2024  Files submitted in CMS for Approval: Printed packets due in Finance: BOC upload /I Board Session email:  6/5/2024 6/11/2024 6/12/2024  FOR FINANCEUSE  REQUIRED APPROVALS  DocuSigned by: Finance. Contracts Docusigned! by: Suott Morvis Legal Counsel  DocuSignedt by: Vanesa KKuk Contract Specialist DocuSignedby: Jaun Frits Chief Administrative Officer  6/5/2024 Date 6/6/2024 Date  6/6/2024 Date 6/6/2024 Date    Ducuoiyr Eivelupe ID.  DLLAEEUD  MARION COUNTY BOARD OF COMMISSIONERS  Mtu  OREGON Board Session Agenda Review Form  Meeting date: June 26, 2024 Department: Business Services  Title:  Third Party Administration for Self-Funded Workers' Compensation Program  June 18, 2024 Contact: Tamra Goettsch  Management Update/Work Session Date: Time Required: 10 min  Audio/Visual aids Phone: 503-589-3200  Requested Action: Business Services requests approve oft the Cannon Cochran Management Services Contract for a  5y year term with at total contract value of $175,201.48.  Issue, &E Description Background:  Marion County's self funded workers' compensation  has a need for at third  program  party  administrator to process claims in compliance with the State of Oregon Workers' Compensation  Division (WCD).  Financial Impacts:  $175,201.48 between July 1, 2024 and June 30, 2029; $33,000 for year 1; 3%  annual increase for years 2,3, 4 and 5  Impacts to Department No impacts to other departments outside of Business Services  & External Agencies:  List ofattachments: Presenter: Department Head Signature:  Cannon Cochran Management Contract  Tamra Goettsch Pocusignedby Tamra Gocttsch    Ducuolyn EIVEIUPE ID. 3IDHAU4E  UDLLHEEUU  SERVICE AGREEMENT BETWEEN MARION COUNTY AND  CANNON COCHRAN MANAGEMENT SERVICES, INC.  THIS SERVICE AGREEMENT is made and entered into this 1st day of July, 2024, by and between Marion County (the "Client"), an authorized self-insured entity, and Cannon Cochran Management Services, Inc. ("CCMSI"), al Delaware corporation. Itis agreed between the parties hereto as follows: A. APPOINTMENT OF CCMSI. The Client hereby appoints CCMSI, and CCMSI hereby agrees to serve, as Third Party Administrator ("Administrator") of the Client's self-insurance program created and existing under the State of Oregon ("State") Self-Insurance Regulations. Marion County grants CCMSI the power of attorney to act on it behalf as required by ORS731.475 (3) and ORS 656.455 (1). B. FUNCTIONS OF CCMSI. During the term of this Agreement, the regular functions of CCMSI as the  Client's Administrator shall include thei following:  1. Claim Administration.  (a) Claim Management and Administration. In compliance with its Best Practices, CCMSI will manage and administer all claims of the Client that occur during the period of this Agreement. All claim payments shall be made with Client funds. CCMSI will act on behalf of Client in handling, monitoring, investigating, overseeing and adjusting all such actual (b) Claim Settlement. CCMSI will settle claims of the Client with Client funds in accordance (c) Claim Reserves. CCMSI will establish reserves for unpaid reported claims and unpaid claim (d) Allocated Claim Expenses. CCMSI will pay, at market rates, all Allocated Claim Expenses with Client Funds. Allocated Claim Expenses are charges for services provided in connection with specific claims by persons or firms which are eligible claim expenses under the Client's program. Notwithstanding the foregoing, Allocated Claim Expenses will include all expenses incurred in connection with the investigation, adjustment, settlement or defense of Client claims, even if such expenses are incurred by CCMSI. Allocated Claim  and alleged claims.  with reasonable limits and guidelines established with the Client.  expenses.  Expenses willi include, but not bel limited to, charges for: 1) Independent medical examinations of claimants;  2) Managed care expenses, which include the services provided by comp mc", CCMSI's proprietary managed care program. Examples of managed care expenses includes but is not limited to state fee schedule, PPO net works, utilization review, nurse case  management, medical bill audits and medical bill review;  SA-Life of Agreement  CCMST    vucuoiyn Civelupe ID,  VUDLAHCCUL  Marion County- SERVICE AGREEMENT  Page 2 of19  3) Fraud detection expenses, such as surveillance, which include the services provided by FIRE, CCMSI's proprietary Special Investigation Unit (SIU), and other related expenses associated with the detection, reporting and prosecution of fraudulent  claims, including legal fees;  4) Attorneys, experts and special process servers; 5) Court costs, fees, interest and expenses;  6) Depositions, court reporters and recorded statements; 7) Independent adjusters and appraisers;  8) Index bureau and OFAC (Office of Foreign Assets Control) charges;  9) MMSEA/SCHIP compliance charges; CCMSI, in conjunction with it reporting agent/MSP vendor, will comply with applicable MMSEA and Section 111 reporting requirements on behalf of the client. CCMSI will provide monthly Medicare eligibility query checks and quarterly mandatory insured reporting compliant with applicable CMS guidelines.  10) Electronic Data Interchanges, EDI, charges if required by State law;  11) CCMSI personnel, at their customary rate or charge, but only with respect to claims outside the State and only if such customary rate is communicated to the Client prior 12) Actual reasonable expenses incurred by CCMSI employees outside the State for 13) Police, weather and fire report charges that are related to claims being administered 14) Charges associated with accident reconstruction, cause and origini investigations, etc.; 15) Charges for medical records, personnel documents, and other documents necessary 16) Charges associated with Medicare Set-Aside Allocations and other related MSP  toi incurring such cost;  meals, travel, and lodging in conjunction with claim management;  under Client's program;  for adjudication of claims under Client's program;  Services;  17) Other expenses normally recognized as ALAE byi industry standards.  (e) Subrogation. CCMSI will monitor claims for subrogation. Schedule of Reports attached hereto as Exhibit A.  (f) Provision of Reports. CCMSI agrees to provide reports to the Client as specified in the  CCMST    Ducuoiyn EIVEIUPE ID.  Marion County- SERVICE. AGREEMENT  Page: 3of19  2. Risk Management Services. CCMSI will provide the Client with additional Risk Management Services not contemplated in the Agreement upon mutual agreement of the parties. The Schedule of additional Risk Management Services to be provided is attached hereto as Exhibit B. 3. Loss Control Services. CCMSI will provide the Client loss control services upon mutual agreement oft the parties. The client shall remain fully responsible for the implementation and operation of its own safety programs and for the detection and elimination of any unsafe conditions or CCMSI assumes no responsibility for the detection, identification, communication, mitigation, or elimination of any unsafe condition or practice associated with the safety program ofa any client. Further, CCMSI assumes no responsibility for anyi injury sustained by an employee of the client. The Schedule of Loss Control Services tol be provided is attached hereto as Exhibit C. 4. Legal Bill Review. / Audit Services. In conjunction with its claims administration services, CCMSI will provide Client with Legal Bill Review / Audit Services (CLEAR). The Schedule of Legal Bill Review / Audit Services, including applicable fees, is attached hereto as ExhibitE. Managed Care Services. CCMSI will provide the Client with managed care services (comp mc") upon mutual agreement of the parties. The Schedule of Managed Care Services to be provided  practices.  is attached hereto as Exhibit D. CLIENT RESPONSIBILITIES. Client agrees to:  1. Report all claims, incidents, reports or correspondence relating to potential claims in a timely  manner.  2. Reasonably cooperate in the disposition of all claims.  3. Provide adequate funds to pay all claims and expenses in a timely manner. 4. Respond to reasonable information requests in ai timely manner.  5. Identify in writing all insurance carriers applicable to CCMSI's claim handling responsibilities contemplated in this Service Agreement that CCMSI will have claim or data reporting requirements. In this regard, Client agrees to provide CCMSI with a complete copy of the current excess or other insurance policies, including applicable endorsements and audits, applicable to Clients insurance program and this Service Agreement. CCMSI assumes no responsibility of any kind for not reporting an otherwise reportable claim to any carrier that Client has failed to disclose to CCMSI and/or provide CCMSI with a copy of the applicable 6. When applicable, obtain and provide to CCMSI an active Registered Reporting Entity (RRE) number through the Centers of Medicare & Medicaid Services that CCMSI is explicitlyauthorized  insurance policy and reporting instructions relative to that carrier.  CCMST    Ducuoiyn civeivpe I.  Marion County- SERVICE AGREEMENT  Page 4of19  to use for mandatory MMSEA Section 111 reporting. When applicable, client agrees to maintain 7. Pay any fees or costs charged by any carrier or prior TPA of Client for the conversion of data associated with CCMSI handling run off claims for Client, or for the general transfer of data to  this RRE # by fulfilling CMS's annual recertification process.  CCMSI'so operating systems. 8. Promptly pay CCMSI'sfees.  D. OPERATING EXPENSES. The Client agrees to be responsible for and pay all of its own operating expenses other than service obligations of CCMSI. Such operating expenses shall include but not be 1. All costs associated with Client meeting its State security and licensing requirements;  limited to charges for the following:  2. Certified Public Accountants  3. Attorneys, other than provided fori in Section B.1. (d) 3) and B.1. (d).4) of this Agreement;  4. Outside consultants, actuarial services or studies and State audits;  5. Independent payroll audits;  Allocated Claims Expenses incurred pursuant to Section B. 1. (d) of this Agreement;  7. Allapplicable regulatory fees and taxes;  8. Educational and/or promotional material, industry-specific loss control material, customized forms and/or stationery, supplies and extraordinary postage, such as bulk mailing, express mail  or messenger service.  9. National Council on Compensation Insurance, NCCI, charges;  10. Excess and other insurance premiums;  11. Costs associated with the development, record keeping and filing of fraud statistics and plans, but onlyi if required by any State or regulatory authority having jurisdiction over Client;  12. Other operating costs as normally incurred by the Client.  E. BOOKS AND RECORDS.  1. (a)CCMSI shall maintain all claim information relating specifically to the Client which is necessary to the performance of CCMSI's obligations under this Agreement (the "Records"). The Records  shall remain at all times the sole property of the Client.  CCMSI    Ducuoiyn Eiveiupe ID.  Marion County- SERVICE AGREEMENT  Page! 5of19  (b)The Records shall not include any manuals, forms, files and reports, documents, customer lists, rights to solicit renewals, computer records and tapes, financial and strategic data, or information which documents CCMSI's processes, procedures and methods, or which CCMSI employs to administer programs other than the Client. The items specified in this Paragraph E. 1. (b) shall at all times be and remain the sole and exclusive property of CCMSI, and the Client shall not have any ownership, interest, right to duplicate or right to utilize these items except for the above documentation or information that relates solely to Client's Program. 2. During the term of this Agreement, CCMSI shall provide the Client with copies of the Records, if so requested by the Client. Any reasonable costs of reproduction of the Records shall be borne 3. CCMSI shall make the Records available for inspection by any duly authorized representative of the Client, or any governmental or regulatory authority having jurisdiction over CCMSI or the F. NON-SOLICITATION OF EMPLOYEES. During the term of the Agreement and for two (2) years thereafter, the Client and CCMSI mutually agree not to recruit, solicit or hire any employee of the G. OTHER INSURANCE. If CCMSI places any specific or aggregate excess insurance, reinsurance, or other insurance product associated with this Agreement, then customary commissions and fees will  by the Client.  Client.  other without written permission.  be retained by CCMSI. H. TERM AND TERMINATION.  1. Term of Agreement. The first term of this Agreement shall be for (5) years beginning on July 1, 2024 and terminating on June 30, 2029. Unless the Agreement is terminated as set forth in paragraph H. 2., it will automatically renew for successive four (4) one (1) year terms. At least ninety (90) days prior to the expiration of each one (1) year term of this Agreement, the parties shall enter into good-faith negotiations regarding any proposed change in Agreement terms or fees. If there are no changes requested by either party, then the Agreement will automatically  renew under the same terms and fee arrangement as the prior term. 2. Termination of Agreement. This Agreement may be terminated: (a) By mutual agreement of the parties hereto;  (b) Upon expiration of the current term of this Agreement if either party has given the other at least ninety (90) days written notice of itsi intention to terminate as set forth inp paragraph H. (c) Upon dissolution of the Client's self-insurance program whether voluntary or due to  1.;  cessation of Client'sauthority to self-insure;  CCMSI    Ducuoiyn Eiveupe ID.  UDLLHEEUU  Marion County- SERVICE AGREEMENT  Page 60 of19  (d) Upon dissolution of the Client's self-insurance program due to Client insolvency or (e) Upon ninety (90) days written notice by either party if the other party is in material breach ofany term, covenant or condition contained herein; provided, however, that as a condition precedent to termination under this Section H. 2. (e), the terminating party shall give written notice to the other party, who shall have sixty (60) days from the date ofs such notice to cure or correct the grounds for termination. If the grounds of termination are not corrected or cured during the sixty (60) day period, this Agreement may be terminated on the termination date specified in the notice, but not prior to the expiration of the ninety  bankruptcy;  (90) day period described herein.  3. Services Following Termination of Agreement. Should this Agreement be terminated or non- renewed for any reason, CCMSI will cease providing services, turn over to the Client all Client Upon the Client's request and subject to agreement by CCMSI, CCMSI will be paid a reasonable  files in CCMSI's possession, which shall include all open and closed files.  negotiated fee to:  (a) Provide for continued administration of the open claim files;  (b) Cooperate with any successor administrator int the orderly transfer of all functions, including providing a runoff listing of open claim files if desired by the Client and any other records (c) Provide an electronic transfer of data if such is feasible, with the cost of providing such borne by the Client. The electronic transfer of data will be subject to a flat fee of $2,500. SERVICE FEE PAYMENTS. The Client shall pay to CCMSI a service fee as outlined in the Fee and ARBITRATION. If an irreconcilable difference of opinion or claim should arise between the Client and CCMSI as the interpreters of any matter relating to this Agreement, such matter will be submitted to mediation or arbitration as the sole remedy available to both parties. Any such mediation or arbitration will take place in Marion County, Oregon and will be conducted in K. RELATIONSHIP OF PARTIES. With respect to the services provided by CCMSI in this Agreement, CCMSI is considered an independent contractor. Nothing in this Agreement shall be construed to create a relationship of employer/employee, partners or joint ventures between the Client and CCMSI. This Agreement is non-exclusive, and CCMSI shall have the right to perform services on  reasonable and necessary for a successor administrator; and  Payment Schedule attached hereto as ExhibitF.  accordance with the then-current rules of the American Arbitration Association.  behalf of other individuals, firms, corporations and entities.  INDEMNIFICATION.  CMSI    Ducuoiyn Envelupe   Marion County SERVICE AGREEMENT  Page7of19  1. Indemnification by Client. The Client agrees that it will indemnify and hold harmless CCMSI and CCMSI's directors, officers, employees, agents, shareholders, subsidiaries and other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorney's fees incurred by CCMSI as a result of breach of this Agreement by the Client, explicit instruction by the Client, or alleged misconduct, error or omissions by the Client, or by any of the Client's trustees, directors, officers, employees, agents, shareholders, subsidiaries, or other affiliates in connection with the performance of this Agreement. Agents as used herein include third party 2. Indemnification by CCMSI. CCMSI agrees that it will indemnify and hold harmless the Client and the Client's trustees, directors, officers, employees, agents, shareholders, subsidiaries, members, or other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorney's fees incurred by the Client as the result of breach of this Agreement by CCMSI or alleged misconduct, error or omissions by CCMSI, or by any of CCMSI's directors, officers, employees, agents, shareholders, subsidiaries or other affiliates in connection with the M. CHANGE IN CIRCUMSTANCES. In the event the adoption of any statute, rule or regulation materially changes the nature of the relationship between the parties hereto or the legal or economic premises upon which this Agreement is based, the parties hereto shall undertake good faith negotiations to amend the terms of this Agreement to account for such changes in a reasonable manner. This includes the happening or development of a local, regional, national or global health situation, crisis, pandemic, or catastrophic event that would impact the volume and type of claims to bea administered by CCMSI under this Agreement. In the event of any such occurrence, either party may contact the other in good faith and seek to amend the terms and /ors service fees applicable to N. SOFTWARE ACCESS. The Client may be provided with the right to use one or more CCMSI Applications in connection with the services provided by CCMSI in this Agreement. CCMSI Applications include iCE, MyReports, Loss Control ASAP, Loss Control Resources and ICEBAR. The right to use CCMSI Applications is non-exclusive, limited to the term of this Agreement per paragraph H.1., non-transferable and is solely for the internal business use of Client. CCMSI owns and reserves all rights, title, and interest in and to the CCMSI Applications. Client has no right to receive a copy of the object code or source code to the CCMSI Applications. Client may 1. License, sell, lease or otherwise make the CCMSI Applications available to any other party. Client will not provide any access, passwords or other information regarding the CCMSI Applications to any third parties and/or competitors of CCMSI without the prior written consent 2. Use the CCMSI Applications in any way that violates any law, regulation or mandate, or the term 3. Take any action thatj jeopardizes confidential or proprietary information held by CCMSI.  vendors selected by Client.  performance of this Agreement.  this Agreement.  not attempt to:  of CCMSI; of this Agreement; or  CMSI    vucuolyn CIveIupe IU. 311  Marion County SERVICE AGREEMENT  Page 8 of19  Client is responsible for any confidential or proprietary information accessed or downloaded by Client from the CCMSI Applications, including the implementation of appropriate information Except as expressly provided in this Agreement, CCMSI Applications are provided "as-is". CCMSI disclaims all other warranties, express, implied, or statutory, including the implied warranties or merchantability, satisfactory quality, title, fitness for a particular purpose, non-infringement, compatibility, security, quiet enjoyment, or accuracy. Without limiting the foregoing, CCMSI does not warrant that access to or use of the CCMSI Applications will be uninterrupted or error-free. CCMSI will provide support for the CCMSI Applications in the two most recent two versions of the  security controls surrounding such information.  Internet Explorer, Chrome, Firefox and Safari browsers.  0. MISCELLANEOUS.  1. Governing Law. This Agreement shall be governed by and construed in accordance with the internal laws of the State of Oregon without regard to principles of conflicts of law. 2. Timing of Services. CCMSI may exercise its own reasonable judgment, within the parameters set forth herein and in compliance with State regulations, as to the time and manner in which it performs the services required hereunder. Additionally, CCMSI will be held to a standard of like 3. Successors in Interest. This Agreement shall be binding upon, and inure to the benefit of, the 4. Severability. The invalidity or unenforceability of any particular provision of this Agreement shall not affect the other provisions hereof, and this Agreement shall be construed in all respects as if the invalid or unenforceable provision had been revised to the minimum extent necessary to 5. Paragraph Headings. All paragraph headings in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation oft this Agreement. 6. Waiver. The failure of any party to enforce any provisions of this Agreement shall not constitute a waiver by such party of any provision. A past waiver of a provision by either party shall not constitute a course of conduct or a waiver in the future with respect to that same provision. 7. Notice Provision. All notices, requests and other communications required under this Agreement shall be in writing and delivered by hand or mailed, registered or certified, return receipt requested, postage paid, or sent via a nationally recognized overnight courier to the  administrators performing like services for customers such as Client. successors in interest and permitted assigns of the parties hereto.  make it valid and fully enforceable under applicable law.  other party at thei following address:  Client:  Marion County P.O. Box 14500 Salem OR 97309  CCMS!:  Cannon Cochran Management Services, Inc.  CCMSI    Ducuoiyn Civeiupe ID.  VUDLL-CEUD  Marion County- SERVICE AGREEMENT  Page9of19  2E. Main St. Danville, IL61832 Attn: Chief Operating Officer  8. File Destruction Policy. CCMSI will maintain electronic claim file records or hard copy files (where applicable) on all closed files on behalf of Client for a period of fifteen (15) years after the month of closure, or for as long as necessary to protect the applicable statute of limitations, whichever is longer. It is the sole responsibility of Client to advise CCMSI if files are not to be 9. Insurance. CCMSI will purchase and maintain insurance coverages for its performance of the services contemplated in this Agreement. Minimum policy limits are as follows:  destroyed per this policy.  Workers Compensation-Statutony Professional $5,000,000 General alwy-sia0p0/s2.0go Umbrella- -S $5,000,000 Cyber Coverage -$5,000,000  10. Escheatment. CCMSI is responsible for complying with all applicable abandoned property or escheat laws, making any required payments, and filing any required reports on CCMSI escrow 11. Confidential Information. Confidential Information includes nonpublic information that is exchanged between the Client and CCMSI, including, without limitation, information relating to the business, financials, personnel, customer data and operating procedures. Confidential Information includes information whether in written, electronic, or oral form created and relating to services provided under the Agreement. All Confidential Information is proprietary. Client and CCMSI may use the other party's Confidential Information only for the purpose of this Agreement and will limit its disclosure to only those persons reasonably necessary to perform under the Agreement. CCMSI will share non-personal bulk claim data with the IDS National 12. Information Security. CCMSI is responsible for the protection of the confidentiality, availability, privacy and integrity of Client information in our custody. CCMSI has implemented an Information Security Policy that has been developed to comply with applicable federal and state laws or regulations and industry best practices. The Information Security Policy applies to all CCMSI personnel, including temporary employees, independent contractors and vendors with 13. Entire Agreementv/Amendmen, This Agreement sets forth the full and final understanding of the parties hereto with respect to the matters described herein, and supersedes any and all prior agreements and understandings between them, whether written or oral. This Agreement may  accounts.  Database unless the Client directs otherwise.  access to CCMSI systems.  be amended only! by written document executed by the Client and CCMSI.  CCMSI    DuLuoiyn CiveIupe ID.  Marion County- SERVICE. AGREEMENT Page 10 of19 Executed this day of  20_  CANNON COCHRAN MANAGEMENT SERVICES, INC.  By:  Rodney. J. Golden  Its: Chief Operating Officer/Executive Vice President  MARION COUNTY SIGNATURES BOARD OF COMMISSIONERS:  Chair  Date Date Date 6/5/2024 Date 6/6/2024 Date 6/6/2024 Date 6/5/2024 Date  Commissioner Commissioner Authorized Signature: Authorized Signature:  DocuSigned by: Tawra Goutsd Department Director or designee DocuSigned! by: Jan Fnta Chiet Administrative Officer DocuSignedby: Suott Morvis Marion County Legal Counsel DocuSignedby: A L - -  Reviewed by Signature:  Reviewed by Signature: E4599AFBGAA5426  Marion County Contracts & Procurement  CCMSI    Ducuoiyn EIveIupe ID.  Marion County- SERVICE AGREEMENT  Page 11 of19  EXHIBIT A SCHEDULE OF REPORTS  1. A detailed listing of all claims broken down by location, policy year and line of coverage. 2. As summary of all claims broken down by location, policy year and line of coverage. (MONTHLY) 3. Acheck register listing all checks issued during a reporting period. (MONTHLY)  (MONTHLY)  CCMSI    vucuoiyn EIVEIUPEI ID.  Marion County- SERVICE AGREEMENT  Page 12 of19  EXHIBITB  SCHEDULE OF RISKI MANAGEMENT SERVICES  No Risk Management Services Included  CCMSI    vucuoiyn civelupe ID.  Marion County- SERVICE AGREEMENT  Page 13of19  EXHIBIT C  SCHEDULE OFI LOSS CONTROL SERVICES  No Loss Control Services Included  CCMSI will provide the Client loss control services upon mutual agreement of the parties. The client shall remain fully responsible for the implementation and operation of its own safety programs and for the detection and elimination of any CCMSI assumes no responsibility for the detection, identification, communication, mitigation, or elimination of any unsafe condition or practice associated with the safety program of any client. Further, CCMSI assumes no responsibility for any  unsafe conditions or practices.  injurys sustained by an employee oft the client.  CCMSI    vucuoiyn Eiveiupe ID.  Marion County- SERVICE AGREEMENT  Page 14 of19  EXHIBITD  SCHEDULE OF comp mc' TM SERVICES AND FEES  Provider Bill Re-pricing  Service  Fee $10.00 per bill $10.00 per bill $1.50 per reportable bill  Usual and Customary re-pricing Fee Schedule state re-pricing Medical Bill State Reporting for applicable medical bills to reportable state  PPO Re-pricing / Out of Network Negotiations  PPOI re-pricing / Specialty and Hospital bill negotiation is billed at 33% of savings  Pharmacy Network Services  Pharmacy Network services are priced at 33% ofs savings.  Note: Managed care services and manage care service fees above does not apply to Oregon  CMSI    Ducuoly" EIVEIUPE ID.  Marion County- SERVICE AGREEMENT  Page 15 of19  EXHIBITE  SCHEDULE OF CLEAR SERVICES ANDI FEES  Service  Description  Service Fee PAID TO BOTTOMLINE TECHNOLOGIES, INC.  Legal Bill Review / Audit Services  Review and audit alll legal invoices submitted 1.95% of the gross monetary by Client-approved law firms for adjudication total of each invoice inc compliance with Client's Defense Counsel submitted and audited  Billing Guidelines and Generally Accepted Legal Billing Principles.  (inclusive of law firm fees, costs and disbursements).  Management Fee for Review Program, administration and integration of data of Performance Reports, and maintenance of technology interface  Integration and interface ofl legal bill review/ necessary to review and adjudicate legal invoices electronically. Periodic standard reports will be developed and produced performance ofl law firms. A Bill Analysis Report (BAR) will be generated for each legal invoice reviewed. The BAR will bei included with each check to the appropriate law firm andi include details and supporting documentation for any deductions applied to the original billing.  PAID TO CCMSI 0.25% of the gross monetary total of each invoice submitted and audited (inclusive of law firm fees,  administration ofl Legal Bill audit software with CCMSI's claim system  reporting and data transfer, summarizing Program's overall savings results. costs and disbursements).  development and delivery Metrics will be applied to analyze the overall  Note: Fees relative to legal bill review services will appear on the transaction register payable to Guarantee: If Legal Bill Review savings achieved for Client is less than the 2.20% total service fee incurred on an annual basis, the Client will be refunded the difference between the service fee incurred and the amount actually saved on invoices. Therefore, service fees will never exceed the savings achieved for Client on an annual basis. Bottomline Technologies, Inc. and CCMSI service fees are paid as ALAE toi the applicable claim file as described in section B. 1.(d)17) of this Agreement.  "CLEAR", CCMSI's proprietary legal bill review program.  No "Clear" Services Included  CCMSI    vocuolyn cuveupe ID.  UDLLHECUU  Marion County- SERVICE AGREEMENT  Page 160 of19  EXHIBITF  FEE ANDI PAYMENT SCHEDULE  Service Agreement Term: July1, 2024 - June 30, 2029  Services:  Fees: $33,000 (minimum annual claims fee)  Claims Administration (minimum)  CCMSI will manage ally workers' compensation claims for the Life of Agreement fora a minimum annual fee of $33,000. This minimum annuali fee will be trued  up annually based on thet following per claim fees:  Workers' compensation: Indemnity claims @ $1100/per claim Mediçal only claims @ $175/per claim  Complex/Enhanced medical only claim surcharge @ $350/per claim  Incident/record only @ $25/per incident end of each one year term.  Any additional charges overt the $33,000 minimum claim fee will bel billed at the There will be a 3%1 feei increase to claim fees int this Exhibit F only per year.  Workers' Compensation Claim Definitions Indemnity Claims  Claims involving lost-time, questionable  compensability, legal involvement/Client attorney representation, subrogation, second injury fund, probable permanent impairment, jurisdictional issues, coverage issues and complex medical issues that are assigned or transferred to indemnity adjusters for claims handling. Medical Only Claims = Claims which have no issues of lost time, no evidence of other indemnity benefit exposure, no obvious question of compensability, no evidence of potential subrogation or second injury recovery, no evidence of problematic medical issues and no requirement or need for any formal statements (3-point or 2-point Complex/Enhanced Medical Only - Medical only claims that have 6or more paid medical transactions and total paid dollars greater than  verbal contact is not required).  $2,500.  CCMSI    vocuoiyn CIVEIUPE ID.  UDLLHEEUL  Marion County- SERVICE AGREEMENT  Page 170 of19  Report Only/Incident Only Claims = Reported claims which require only input into RMIS system and requires no claims management  activity. Annual Administration Fee  $5,000  Dedicated client service team Monthly loss reporting Issuance of 1099's assessments  Development of specific client service requirements Quarterly claim reviews at client's request  Assistance in filing of all required state forms including state mandated ol IfClient has directed CCMSI to utilize at third party vendor selected by Client for the provision of services then such assistance will be the responsibility of the third party vendor Workers' compensation claim packets/state forms Preparation for, compliance with and response to regulatoryaudits Account Management and Administration  Annual Internet Claim Access Fees Internet claims system access which includes: Viewing access to all claims data Risk Management statistical analysis On-line reporting capability via the internet Ability to generate First Notice of Loss  $2,500  Comprehensive and complete access to claims management process  On-line reports  Managed Care Service Fees  See Detail  Provider Bill Re-pricing  Service  Fee $10.00 per bill $10.00 per bill  Usual and Customary re-pricing Fee Schedule state re-pricing Medical Bill State Reporting for  applicable medical bills to reportable $1.50 per reportable bill  state  PPO Re-pricing /C Out of Network Negotiations  PPO re-pricing /Specialty and Hospital bill negotiation is billed at 33% of  savings  CMSI    Ducuolyn Eiveivpe ID. J1UAAL U42-LOnU-H  VUDLL-EEUL  Marion County- SERVICE AGREEMENT  Page 18 of19  Pharmacy Network Services  Pharmacy Network services are priced at 33% of savings.  Note: Managed care services and manage care service fees above does not  apply to Oregon State Reporting EDI Fees Index Bureau  Current Market Rate Current ISO Market Rate Current Market Rate  Note: The index fee is a direct pass through charge for ISO. IfISO increases their current market rate per index, CCMSI will adjust thet fee accordingly. Mandatory MMSEA Compliance Section 111 Reporting Fee  CCMSI, in conjunction with its reporting agent / MSP Vendor, will comply with applicable MMSEA and Section 111 reporting requirements on behalf of Marion All qualifying injury claims willl be queried to CMS to determine  County.  Medicare eligibility.  CCMSI will collect additional mandatory data on claims where Medicare eligibility has been verified. CCMSI, along with its reporting agent, will report all claims meeting the reporting guidelines as set forth by CMS. CCMSI will provide ongoing monthly Medicare eligibility query checks and continued quarterly mandatory insured-reporting compliant with  applicable CMS guidelines.  Note: In order for CCMSI and its reporting agent to comply with mandatory Section 111 reporting, the client must provide CCMSI an active RRE # wherein CCMSI is explicitly authorized to report data on the client's behalf.  Carrier Fees  TBD  Ifapplicable, Client will be responsible for payment of any carrier fees associated with the transition of claim handling responsibilities to CCMSI.  Special System Reports  $125 an hour  CCMSI will provide special reports, (reports not currently programmed or written) for a fee of $125 per hour for system programming time. CCMSI will provide an estimate of charges before any work will be done.  Taxes  See Detail  CCMST    Ducuoiyn Euvelupe D.  Marion County- SERVICE. AGREEMENT  Page 19 of19  CCMSI fees will bei increased by any applicable Sales, Gross Receipts, or similar (excluding income) taxes imposed by Federal, State or Local bodies.  GRAND' TOTAL Fee & Payment Schedule ofi invoice.  $40,500  The quarterly installments of $10125.00 will be due within 30 days from receipt Subsequent year per claim fees shall be subject to an annual increase of 3% as  previously indicated in Exhibit F.  CMSI