23CSMC-213C-Q_As-05.03.24-FINAL.pdf

California Department of Insurance (CDI) RFP# 23CSMC-213C - Independent Medical Review

Proposer Questions

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1. RFP Page # 3 of 61, Section # Purpose (Background) and Description of Services, RFP Text: The purpose of this RFP is to solicit proposals that will lead to the selection of a prime contractor to provide Independent Medical Reviews (IMR) for CDI.

Question: Who currently holds this contract? Is this contract currently subcontracted? Is there more than one contractor currently?

CDI Response: This information may be requested via Public Records Act (PRA) request by submitting to CustodianofRecords@insurance.ca.gov.

2. RFP Page # 4 of 61, Section # Step 4: The Contractor/Proposer will obtain the review, RFP Text: The Proposer will obtain and review the reviewers’ findings and submit the determination in writing to the HCB, insured, insurer, and the insured’s medical provider within thirty (30) days.

Question: Is the determination mailed to all parties? Is email or fax acceptable?

CDI Response: The Department will receive an electronic copy. A hard copy is mailed to the insured and insurer.

3. RFP Page # 4-5 of 61, Section # 2) Contract Scope of Work (Narrative Response), Step 5, Available Staff, RFP Text: The Proposer shall provide names, locations, board specialties, areas of expertise, and California license status of medical reviewers available to the Proposer.

The Proposer shall describe the relationships (staff, independent contractor). Information on available non-physicians shall also be provided.

Question: Do all the Proposer’s qualified medical reviewers need to have California licenses, or can the Proposer use other qualified medical reviewers to conduct reviews?

CDI Response: It is required that preference be given to California-licensed reviewers except when training and experience with the issue reasonably requires the use of an out-of-state reviewer. For additional details about reviewer requirements, please refer to CIC 10169.2, specifically subsection (d)(4) regarding the qualifications of reviewers.

4. RFP Page # 5 of 61, Section # Proposer shall verify capability to prove the following services:

RFP Text: The Proposer must have appropriate staff available to perform professional and nonprofessional assignments required by the IMR program.

Question: What are the top 5 professional and nonprofessional assignments required by the IMR program?

CDI Response: CDI’s IMR statistics dating back to 2011 are publicly reported on CDI’s website. (Go to: File a Complaint -> IMR Program -> IMR Statistics) CDI IMR Statistics

5. RFP Page # 5 of 61, Section # Proposer shall verify capability to prove the following mailto:CustodianofRecords@insurance.ca.gov https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=10169.2&lawCode=INS https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=10169.2&lawCode=INS https://interactive.web.insurance.ca.gov/apex_extprd/f?p=192:1:3412505892979:::::

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RFP Text: The Proposer shall provide consulting and research services, which will include reviews of health care treatments or clinical issues regarding health insurance that will assist the Department on matters that do not involve a particular insureds grievance.

Question: Can the Department provide an example of a healthcare treatment or clinical issue for which the Proposer would provide consulting or research services?

CDI Response: To date, CDI has not needed to utilize this service.

6. RFP Page # 6 of 61, Section# Proposer shall verify capability to prove the following

RFP Text: Following at least one week’s notice, or seven (7) calendar days, the Department (or a Proposer or consultant acting on behalf of the Department) may conduct an on-site quality assurance review of the Proposer’s office procedures and record systems as may be deemed necessary by the Department.

Question: Would the Department consider conducting a virtual quality assurance review of the Proposer’s procedures and record systems if the Proposer is a fully remote organization?

CDI Response: CDI will evaluate the manner in which to complete a quality assurance review at the time a review is deemed necessary.

7. RFP Page # 9 of 61, Section # Number and Types of Reviewers, RFP Text: For medical necessity reviews, the Proposer will normally select the medical specialties and number of reviewers required to render a timely, objective, and effective review.

Question: Is one reviewer acceptable for medical necessity reviews?

CDI Response: Yes, one reviewer is sufficient for medical necessity reviews.

8. RFP Page # 14 of 61, Section # B) Minimum Qualifications for Proposers, RFP Text: Proposer must give evidence that it has at least one (1) California office and will provide service through this location.

Question: We are a fully remote organization currently conducting business in the State of California. Does the selected Proposer need to have an office in California, or will CDI allow the Proposer to conduct this work remotely, as we currently do?

CDI Response: The Insurance Code requires that the IMRO be “in the State”

9. RFP Page # 18 of 61, Section # 4) Cost Proposal, RFP Text: Complete a cost proposal….

Question: What is the current pricing for this contract? Please detail.

CDI Response: This information may be requested via Public Records Act request by submitting to CustodianofRecords@insurance.ca.gov mailto:CustodianofRecords@insurance.ca.gov

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10. RFP Page # 18, Section Name: Section C), Proposal Requirements and Information, The RFP states: “Anticipated maximum value of $750,000.00 is projected during the term of the contract. This figure is based on service fees. Service fees shall include out-of-pocket costs, reimbursements and any other related service fees, with a ceiling on the total contract amount.”

Question: Is $750,000 the total anticipated funding for all five years of the contract? Given that the prior contract value of this work was $1,750,000.00, has the Department decided to reduce the funding for this work?

CDI Response: Yes, $750,000 is the total funding for the term of the contract. Yes, the CDI determined the value of this contract to be $750,000 for the term of the contract.