01 BDD Psych Consults SOW_Final.docx

STATEMENT OF WORK

BDD PSYCH SERVICES

6100055942

A. CONTRACT SCOPE/OVERVIEW: The Department of Labor and Industry (DLI), Bureau of Disability Determination (BDD) is issuing this Invitation for Bids (IFB) solicitation to procure Psychological and Psychiatric Case Review services. Psychiatrists and psychologists will be required to perform work that involves reviewing cases to determine a claimant’s eligibility for disability benefits under the Social Security Act. Each awarded bidder will serve as a resource to medical, adjudicative, supervisory, and administrative staff when questions or problems arise related to the psychiatrist’s or psychologist’s area of specialty. An awarded bidder may need to communicate with treating physicians, consultants, and other health care providers to elicit or clarify medical evidence; assist in training medical and lay staff; and participate in Social Security Administration (SSA) or BDD-sponsored medical conferences, seminars, and events.

Estimated Case Volume for Agency Per Year: 116,832. Case volume estimates are strictly estimates based on historical data, and actual case volumes may differ. There is no minimum volume guaranteed.

Historically, services had been performed at one of the following BDD locations. The Commonwealth is currently working under the telework program, and cases are distributed electronically. Should telework circumstances change, Contractors will be provided notification. Teleworking may be available at the sole discretion of BDD.

1171 South Cameron Street, Harrisburg, PA 17104 (Dauphin County) 47 South Washington Street, Wilkes Barre, PA 18702 (Luzerne County) 144 North Main Street, Greensburg, PA 15605 (Westmoreland County)

B. METHOD OF AWARD: This is a multiple award contract. Additionally, this solicitation is reserved for Department of General Services (DGS) Certified Small Businesses. Only DGS Certified Small Businesses will be considered for award as per Terms and Conditions I.2 IFB-001.1b Purpose - Restricted Small Business Procurement (July 2012). Bidders will attach the DGS Small Business Certificate to their SRM bid.

Bidders who are interested in participating in this program may find more information about the Small Business Contracting Program and how to self-certify at www.dgs.pa.gov/bdisbo.

No work may be performed without the issuance of a purchase order.

C. PRICE SUBMITTAL: Bidders must submit an all-inclusive case bid price electronically in the SRM bid.

D. ELIGIBILITY REQUIREMENTS: Contractors must comply with the specifications and service requirements identified in this section.

· Psychiatrists must have an active, unlimited license in good standing to practice medicine in the Commonwealth of Pennsylvania. Professional qualifications will be considered in the following order of preference:

· Diplomate of the American Board of Psychiatry and Neurology with certification in psychiatry.

· Completion of a Board approved residency in psychiatry without Board Certification.

· Psychologists must have an active unlimited license in good standing to practice psychology in the Commonwealth of Pennsylvania AND EITHER:

· Possess a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council for Higher Education Accreditation, formerly the Council on Post-Secondary Accreditation OR

· Be listed in the National Register of Health Service Psychologists AND possess two (2) years of supervised clinical experience as a psychologist in health service, at least one year of which is post master’s degree.

· Contractors must be able to provide services to BDD at a minimum of 40 case reviews per five (5)-day work week. In addition, the number of cases requiring completion may be increased or decreased based upon the caseload that BDD must service. BDD may add additional bidders if necessary, to service its caseload.

· Contractors and their employees and/or sub-contractors must be proficient in using a computer with a Windows-based platform.

· Contractors and/or sub-contractors must comply with all directives issued by BDD as they relate to services provided.

· Contractors and their employees and/or sub-contractors must have the ability to maintain good working relationships with Disability Claims Adjudicators, Clericals, Supervisors, and Managers who have administrative responsibility for disability determinations.

· Contractors and/or sub-contractors must be cleared and not found unsuitable under Homeland Security Procedure Directive-12 (HSPD-12) Homeland Security Presidential Directive 12 | Homeland Security (dhs.gov).

· Contractors and/or sub-contractors must not be excluded from participating in the Medicare and Medicaid programs.

E. INSURANCE: Contractors must comply with the insurance requirements identified in this section.

Psychiatrists will be required to provide medical malpractice insurance in accordance with the Medical Care Availability and Reduction of Error (MCARE) Act. - (40 P.S. §§ 1303.101-1303.1115). Such insurance shall insure the interests of both the Contractor(s) and the Commonwealth of Pennsylvania (COPA) against any and all claims which may arise out of the bidder(s) operations under any contract resulting from this IFB. In the event that any carrier of such insurance issues a notice of cancellation, prior to the expiration date, the Contractor must immediately notify BDD of such notice of cancellation.

Psychologists will be required to provide malpractice insurance. This malpractice insurance shall insure the interests of both the Contractor(s) and COPA against any and all claims which may arise out of the bidder(s) operations under any contract resulting from this IFB. The basic insurance coverage will be $750,000 per occurrence or claim, and $2,250,000 per annual aggregate. In the event that any carrier of such insurance issues a notice of cancellation, prior to the expiration date, the Contractor(s) must immediately notify BDD of such notice of cancellation.

F. TRAINING:

Contractors and their employees and/or sub-contractors attending any training provided by BDD will be paid at an hourly rate of $80.00.

Initial Training

Contractors who do not meet the minimum two (2) years’ experience performing Psychiatric/Psychological services for BDD, as administered by the SSA, are required to attend up to 45 hours of combined classroom and online policy and procedure training prior to performing any case reviews. Contractors are responsible for initial training of any of its employees and/or sub-contractors unless otherwise directed by BDD. By the end of the initial training period, the Contractor, and its employees and/or sub-contractors are expected to achieve independent case reviewer status and will be subject to mandatory case reviews for a period of time determined by BDD.

Ongoing Training

Contractors will be required to attend ongoing training necessary to perform independent case reviews and meet mandated training requirements of SSA and/or COPA. Examples of such training include but are not limited to SSA/BDD policy updates, procedural changes, or regulatory changes. Selected bidders and their employees and/or sub-contractors may also be required to attend additional training at the discretion of BDD. Unless specified by BDD, selected bidders are responsible for providing ongoing BDD-required training to their employees and/or sub-contractors.

When possible, BDD will provide at least two (2) weeks’ notice of ongoing training. At the discretion of BDD, employees and/or sub-contractors of a Contractor may be required to attend training and must be available at a date and time directed by BDD.

It is the Contractor’s responsibility to ensure that its employees and/or sub-contractors are available to attend required training. BDD has the option to waive attendance for training(s).

In order to request a waiver for non-attendance of training, the Contractor must submit a written request to BDD within one (1) week of the training notification. Unapproved non-attendance for a Contractor or its employee and/or sub-contractor at required ongoing training may result in any of the remedies in of the PERFORMANCE STANDARDS, Independent Case Reviews (below). Make-up training sessions will be provided at the discretion of BDD. Contractors are responsible for making up missed training and/or providing training missed by their employees and/or sub-contractors at no cost to BDD. Payment for self-review of training materials will be at the discretion of BDD.

G. JOB DESCRIPTION:

Independent Case Reviews

Contractors and their employees and/or sub-contractors will review claims for disability under the Social Security Act to help determine eligibility for benefits. The evaluation of applications based on mental disorders requires consideration of the nature and clinical manifestations of the medically determinable impairment(s) as well as consideration of the degree of limitation such impairment(s) may impose on the individual’s ability to work and/or function.

The evaluation will be based on evidence from physicians, psychologists, and other medical, non-medical, and third-party sources. The evaluation will consider evidence including but not limited to clinical signs, symptoms and laboratory findings, including the results of psychological testing, and evidence of an individual’s functioning across different settings. The degree of functional limitation will be rated in four broad areas:

· Understanding, remembering or applying information;

· Interacting with others;

· Concentrating, persisting, or maintaining pace; and,

· Adapting or managing oneself.

Case reviews involve evaluation of the degree and duration of impairment and may include determination of residual functional capacity, onset, or cessation dates, need for reexamination, or other issues. Determinations require completion of forms explaining medical determinations, adequacy of documentation, and any other matter needed to support the determination.

At the discretion of BDD, cases may be assigned from any location up to the number of cases bid.

Selected bidders and their employees and/or sub-contractors must:

· Serve as a resource to medical, adjudicative, supervisory and administrative staff on claims relating to the bidder’s area of specialty;

· Communicate with treating physicians and other health care providers to elicit or clarify medical evidence;

· Record findings in the Bureau’s electronic process systems as specified by BDD case review policies and procedures;

· Attend required meetings, briefings, and workgroups necessary to perform independent case reviews (e.g. policy updates, procedural changes) or to discuss administrative issues related to this contract;

· Provide a satisfactory written assessment that can be utilized by others in the disability program;

· Make corrections to returned case reviews at no additional cost to BDD;

· Keep abreast of SSA policy and current medical research, as this is necessary for successful independent case review. This includes reading correspondence (including e-mails) related to the duties the selected bidder and/or its employee and/or sub-contractor must perform under this contract; and,

· Immediately notify BDD in writing of any adverse action regarding the license of a Contractor or its employees and/or sub-contractors to practice medicine or psychology.

Non-Case Review Services

BDD may require the selected bidder to perform professional consultative services related to their practice that are not directly associated with any particular case or case review. These services will be reimbursed at $80.00 per hour and may include, but are not limited to:

· Participate in presentations related to the selected bidder’s medical specialty and the application of disability policies;

· Provide consultation and expertise on policy development issues including written and/or oral summarizations;

· Participate in workgroups, visits, and meetings as requested by BDD to discuss issues related to the disability process; e.g. new medical technologies, revision of medical listings, and other policy issues (this does not include meetings, briefings, or workgroups necessary for independent case reviews);

· Assist BDD in providing one-on-one orientation to other medical reviewers; and/or,

· Assist with training of other medical staff and lay staff.

H. PERFORMANCE STANDARDS:

Independent Case Reviews

· Contractors and any of their employees and/or sub-contractors are required to perform case reviews at a monthly accuracy rate of at least 93% for BDD to consider such performance satisfactory. BDD will calculate monthly accuracy rates based upon total BDD internal quality assurance sampling for the calendar month. Monthly accuracy rates will be reported as an average of combined accuracy rates from deficiency Group I and TCA (Groups III and IV) defined by SSA. Failure to meet this standard for three (3) consecutive calendar months may result in any of the actions outlined in subsection (7) below.

· Contractors and any of their employees and/or sub-contractors must complete any assigned case review within two (2) business days of receiving a case assignment.

· Case reviews must address all relevant issues in accordance with applicable SSA authorities including, but not limited to the Social Security Act, SSA’s Program Operations Manual System (POMS), federal regulations, Social Security Rulings, and Acquiescence Rulings. Case reviews must be presented in an unbiased, logical, and understandable manner. The entire case file must be considered. BDD will pay particular attention to the adequacy of the documentation, the review and determination regarding the claimant’s onset of disability, and the severity and expected duration of the claimant’s medical impairment. BDD will return case reviews that fail to comply with SSA authorities to the reviewer for correction or clarification of the issue(s). A Contractor and its employee and/or sub-contractor shall perform the correction at no additional cost to BDD. If the selected bidder’s employee or sub-contractor is no longer working for the selected bidder, the Contractor will correct the case.

· Contractors and their employees and/or sub-contractors must respond promptly to all questions posed by BDD regarding the case. If the Contractor’s employee or sub-contractor is no longer employed by the Contractor, the Contractor is responsible for responding.

· Contractors and their employees and/or sub-contractors must maintain a valid license at all times during the performance of an awarded contract. BDD must be notified promptly of any revocation, suspension or similar invalidity involving the license of the selected bidder or its employees and/or sub-contractors.

· Invoices for services rendered must be submitted to BDD bi-weekly. BDD must receive all invoices within 60 days from the date the services were performed. Failure to meet this standard may result in any of the actions listed.

Failure by any selected bidder or its employee and/or sub-contractor to meet any of the conditions may, at BDD’s discretion, result in, but is not limited to:

· Termination of the contract where the failure is by the Contractor;

· Preclusion of the non-satisfactory selected bidder or its employee and/or sub-contractor from working on BDD cases;

· Additional training for the selected bidder and its employees and/or sub-contractors as deemed necessary by BDD; and/or,

· Reduction of cases assigned.

Non-Case Services’ Standards

With respect to non-case services, BDD will use the following standards to measure the performance by a selected bidder or its employees and/or sub-contractors:

· Prepares oral and written presentations appropriate for the intended audience;

· Responds to all questions posed by BDD staff regarding his/her deliverables or performance under this task;

· Completes assigned tasks within acceptable timeframes as defined by BDD; and,

· Provides final product consistent with BDD policy and it’s presented in an unbiased, logical and understandable manner.

I. TRAVEL:

Contractors and their employees and/or sub-contractors are responsible for travel costs necessary to arrive at the work location. If attendance is necessary for medical meetings or providing training to BDD employees in locations other than the usual place of performance, BDD will provide reimbursement for travel expenses in accordance with Management Directive 230.10 Amended, Commonwealth Travel Policy Manual (pa.gov), regarding Travel and Subsistence Allowances.

J. REPORTS:

Contractors and their employees and/or sub-contractors must maintain and submit accurate records of time spent and number of completed case reviews. Selected bidders and their employees and/or sub-contractors may be required to submit other reports deemed necessary by the BDD.

K. CONFLICT OF INTERESTS:

Neither a Contractor nor any of its employees and/or sub-contractors will perform consultative examinations for any State Disability Determination Service (DDS) or component of SSA that performs services for the Social Security Disability and/or Supplemental Security Income programs.

By submitting a response to this IFB, a bidder(s) agrees that bidder(s) and any employee and/or sub-contractor will disqualify himself/herself from any case in which s/he has any professional, familial, financial, or other relationship to the claimant.

ADDITIONAL COPA EMPLOYMENT:

If it is determined that due to a bidder’s employment or contractual agreement with another COPA agency and that a dual state employment issue exists, as defined in Management Directive 525.11, 525-11 (pa.gov), BDD may be required to reduce the bidder’s price and/or hours of service.

Bidder must disclose any current Commonwealth employment or contractual agreements by bidder and any of its employees and/or sub-contractors in any response filed to this IFB.

L. ITEMS TO BE RETURNED WITH BID: The following documents should be named appropriately and submitted individually (or grouped as necessary, by type) with your electronic bid in either MS Word or PDF format as applicable for bidder and all employees and/or sub-contractors:

· Appendix A-1 Psychiatrist AND/OR Appendix A-2 Psychologist

· Insurance documents as outlined in this SOW, section E.

· Current DGS Small Business Certification

· Current Background check

· Curriculum Vitae

· DOS License

· Diploma

· Transcripts

· Domestic Workforce Utilization Certification

· Lobbying Certification Form

· Worker Protection and Investment Certification Form

M. Contracting Office: All questions in reference to this IFB, should be directed via email to:

Nicole Moyer, Contracting Officer Bureau of Administrative Services, Procurement Division 651 Boas Street Harrisburg, PA 17121 Email – nicomoyer@pa.gov