Addendum 2~24.pdf

The Commonwealth of Massachusetts Executive Office of Energy and Environmental Affairs

100 Cambridge Street, Suite 900 Boston, MA 02114

Maura T. Healey

GOVERNOR

Kimberley Driscoll

LIEUTENANT GOVERNOR

Rebecca L. Tepper

SECRETARY

Tel: (617) 626-1000 Fax: (617) 626-1081 http://www.mass.gov/eea

Request for Response Independent Medical Examination

BID # BD-27-1042-ENV-ENV01-133439

Addendum # 2 September 23, 2026

RE: Addendum No. 2 – RFQ Solicitation Document Update

To: All Proposers/Bidders of Record:

Please be advised that the RFQ Solicitation Documents for the above-referenced project have been modified, corrected, and/or supplemented as follows. Addendum No. 2 is hereby incorporated into the Contract Documents.

Purpose of Addendum:

The purpose of this addendum is to provide responses to questions submitted by proposers and attached is the updated 3.6 Compensation Structure and Pricing. All clarifications, explanations, and additional information are now part of the Contract Documents.

1. Who is the incumbent vendor of these services?

Response: CorVel and Scope Medical, LLC

2. Can a vendor submit for just IME services or one of the other components or just you submit for all services?

Response: Bidders are expected to submit a quote that addresses all services outlined in the RFR. Quotes limited solely to IME services or to individual service components are not contemplated under this procurement.

3. Where would a provider indicate the pricing for medical cost containment and managed care services (bill review, nurse case management, UR, diagnostics testing etc.

Response: Providers should include pricing for all medical cost containment and managed care services in their Cost Proposal. Pricing should be itemized by service, including, but not limited to, bill review, nurse case management, utilization review (UR), diagnostic testing, and any other related services proposed by the provider.

4. Is the expectation the vendor will provide a list of specialties and number of physicians or are you looking for some other type of information for network coverage.

Response: The expectation is for vendors to provide a comprehensive list of all medical specialties available within their provider network, including the number of physicians available for each specialty.

5. As our network is large in size, is a representative sample of resumes acceptable to meet the qualifications/experience requirement?

Response: Proposers must provide resumes for all service specialists proposed to perform services under the contract. Each resume should clearly demonstrate the individual's relevant qualifications, credentials, and experience. A representative sample of resumes will not satisfy this requirement.

6. Please provide historical utilization data for the past three (3) contract years, broken out by service type, including: o IMEs by specialty o Fitness-for-duty examinations o Return-to-work evaluations o Medical record reviews o Nurse case management referrals o Utilization reviews o Medical bill review transactions o Drug utilization reviews o Diagnostic testing coordination requests o Physician depositions and hearing testimony requests

Response: For the most recent contract year, utilization was as follows: 22 orthopedic IMEs, 5 psychological IMEs, 9 fitness-for-duty examinations, 3 return-to-work evaluations, and 2 medical record reviews. Additionally, there were more than 50 utilization reviews and more than 100 medical bill review transactions.

There were no nurse case management referrals, drug utilization reviews, diagnostic testing coordination requests, physician depositions, or hearing testimony requests during the most recent contract year.

Historical utilization data for the preceding two contract years is not available.

7. What percentage of referrals are IMEs versus fitness-for-duty or other employment-related evaluations?

Response: Based on historical utilization, approximately 90% of referrals are for IMEs and approximately 10% are for fitness-for-duty evaluations.

8. What is the anticipated annual spend for IME services and managed care services under this contract?

Response: The estimated average annual expenditure for IME and managed care services is approximately $40,000. This amount is an estimate based on historical utilization and does not represent a guaranteed level of expenditure under the resulting contract.

9. Approximately how many referrals require physician testimony, depositions, or court appearances each year?

Response: During the most recent fiscal year, there were no referrals requiring physician testimony, depositions, or court appearances. Future utilization may vary based on program needs.

10. How many utilization reviews, nurse case management assignments, and bill review transactions are expected annually? 4

Response: Estimated annual utilization is approximately 50 utilization reviews, 4–5 nurse case management assignments, and more than 100 medical bill review transactions.

These figures are estimates based on anticipated utilization and do not represent guaranteed volumes.

11. What percentage of examinations are typically psychiatric/psychological versus physical medicine specialties?

Response: Based on historical utilization, approximately 10% of examinations are psychiatric/psychological, with the remaining approximately 90% involving physical medicine or other non-psychiatric/psychological specialties.

12. How many employees are currently covered under the EOEEA Injury on Duty program?

Response: The EOEEA Injury on Duty program covers law enforcement officers within the Massachusetts Environmental Police. The number of employees currently covered is not available at this time.

13. Beyond the medical specialties listed in the pricing schedule, what additional specialties have historically been utilized and what were the related annual referral volumes?

Response: The RFR has been updated to include additional medical specialties anticipated to meet EOEEA’s needs. Historical referral volumes for these newly added specialties are not available.

14. For historical IMEs, approximately what percentage involved: o Less than 250 pages of records o 251-500 pages of records o More than 500 pages of records.

Response: Historically, the majority of IMEs have involved fewer than 250 pages of medical records. A percentage breakdown by record-volume category is not available.

15. Can EOEEA provide historical referral volume by county or region?

Response: No. EOEEA’s current system does not capture or report historical referral volume by county or region.

16. Are there specific counties or regions where provider shortages currently exist?

Response: No specific counties or regions with provider shortages have been identified at this time.

17. How frequently are out-of-state examinations required?

Response: During the most recent fiscal year, EOEEA did not require any out-of-state examinations. Future utilization may vary based on program needs.

18. What surrounding states are considered acceptable for provider access requirements?

Response: We encourage the providers to stay within the Commonwealth.

19. Can EOEEA define the Tier 1, Tier 2, and Tier 3 physician classifications referenced in the pricing tables?

Response: EOEEA has revised Section 3.6, Compensation Structure and Pricing, to remove the Tier 1, Tier 2, and Tier 3 physician classifications. Please refer to the revised Section 3.6 included as part of this Addendum.

20. Are board certification requirements mandatory for all specialties?

Response: Yes. Board certification is required for physicians in all applicable medical specialties.

21. Are physician CVs required at proposal submission or only after award as this could be hundreds of pages based on the size of our network?

Response: Physician CVs are required at the time of proposal submission for all physicians proposed to provide services under the contract. CVs must demonstrate the applicable qualifications, credentials, and experience.

22. For purposes of physician network participation, will contract physicians and physician groups be considered approved subcontractors under the contract, or will separate EOEEA approval be required for each participating provider or provider group? If subcontractor approval is required, may providers be added and removed through a periodic reporting and notification process, rather than requiring advance approval for each provider change?

Response: EOEEA approval will be required prior to the participation of each provider or provider group under the contract. Any providers or provider groups added during the contract term must receive EOEEA approval before providing services.

23. Are psychologists permitted to perform fitness-for-duty evaluations when clinically appropriate?

Response: Yes. Psychologists may perform fitness-for-duty evaluations when clinically appropriate and when they possess the appropriate qualifications and credentials to perform the evaluation.

24. May the Contractor utilize independently contracted physicians, physician groups, and subcontracted provider networks to satisfy the physician network requirements of this contract?

Response: Yes. EOEEA will allow contractors to utilize independently contracted physicians, physician groups, and subcontracted provider networks to meet the requirements of this contract. However, the primary contractor will remain responsible for ensuring that all providers meet the required qualifications, licensing, availability, and service standards outlined in the contract. The primary contractor will also be responsible for coordinating appointments, maintaining quality of services, and ensuring timely completion and submission of medical evaluation reports.

25. What documentation will satisfy the requirement to demonstrate physician network adequacy and statewide physician availability? o For example: * Provider roster * Letters of commitment * Network maps * Other documentation

Response: Proposers must provide a provider roster and network coverage map(s) demonstrating the availability and geographic distribution of physicians within the proposed network.

26. Is a physician listing sufficient for proposal evaluation purposes, or are letters of commitment required from participating providers?

Response: Please refer to the response to Question 25. A provider roster and network coverage map(s) are required to demonstrate physician network adequacy and availability.

27. What percentage of referrals are considered urgent?

Response: Approximately 25% of referrals are estimated to require urgent or expedited handling. Actual utilization may vary based on program needs.

28. Does EOEEA have specific service level requirements for appointment availability?

Response: EOEEA expects vendors to provide timely appointment availability for Independent Medical Examinations (IMEs), fitness-for-duty evaluations, and return-to-work assessments. Appointments should be scheduled and confirmed within 5 business days of receiving the request, with the actual examination taking place within 10-15 business days, whenever possible. Urgent cases should be prioritized and accommodated sooner when necessary. Vendors should also offer flexible scheduling options for Massachusetts Environmental Police Officers who work second and third shifts, weekends, and nontraditional schedules, including early morning, evening, or weekend appointments when available. Vendors must promptly notify EOEEA of any scheduling delays and provide alternative appointment dates when necessary.

29. Are turnaround requirements measured from the examination date or from receipt of all records?

Response: Turnaround time is measured from the date of the examination. IME reports must be completed and returned within 10 business days following the examination.

30. If additional records are requested after the examination, does the 10-business-day report clock pause?

Response: Yes. If additional records necessary to complete the evaluation are requested after the examination, the 10-business-day turnaround period will be paused until the requested records are received. The vendor should promptly notify EOEEA of any anticipated delay.

31. Please define EOEEA's expected turnaround times for: o Routine IMEs o Expedited IMEs o Fitness-for-duty examinations o Report delivery o Addendum requests

Response: EOEEA’s expected turnaround times are as follows:

• Routine IMEs: 10 business days

• Expedited IMEs: 5 business days

• Fitness-for-duty examinations: 5 business days

• Report delivery: 5 business days

• Addendum requests: 5 business days

Turnaround times will be measured from the applicable examination, referral, or request date, unless otherwise specified by EOEEA.

32. Will EOEEA provide standard fitness-for-duty evaluation criteria for Environmental Police Officers?

Response: Yes. EOEEA will provide the applicable fitness-for-duty evaluation criteria for Environmental Police Officers when such an evaluation is requested.

33. For which examination types will telehealth evaluations be considered acceptable, if clinically appropriate?

Response: Telehealth evaluations may be considered on a case-by-case basis when clinically appropriate and approved in advance by EOEEA. The examination must be suitable for telehealth and meet all applicable professional, licensing, confidentiality, and evaluation requirements.

34. For ophthalmology-related evaluations, may diagnostic testing be performed through qualified third-party facilities when necessary?

Response: No. Diagnostic testing associated with ophthalmology-related evaluations may not be performed through third-party facilities.

35. For utilization review, are you open to first level review by a physician?

Response: Yes. First-level utilization review may be performed by a qualified physician.

36. Which managed care services are currently being used by EOEEA?

Response:

EOEEA currently utilizes two vendors for managed care and medical evaluation services:

• CorVel Corporation: Provides managed care services for Massachusetts

Environmental Police Officers injured in the line of duty under M.G.L. Chapter 21A, Section 10J. Services include medical bill review, utilization review, Independent Medical Examinations (IMEs), and other injury-related medical evaluations.

• Scope Medical: Provides IME service for fitness-for-duty and return-to-work evaluations for employees with non-work-related medical conditions to determine their ability to safely perform their job duties.

EOEEA currently utilizes medical bill review, utilization review, IMEs, fitness-for-duty evaluations, and return-to-work assessments. Nurse case management, drug utilization review, and diagnostic testing coordination are not routinely utilized but may be requested as needed under the new contract.

37. Are all managed care services expected from a single contractor, or may services be subcontracted?

Response: The awarded Contractor will be responsible for ensuring that all required managed care services are provided under the contract. The Contractor may provide these services directly or utilize qualified subcontractors, including independently contracted physicians, physician groups, and provider networks, subject to prior EOEEA review and approval. The primary Contractor will remain fully responsible for the quality, performance, timeliness, and compliance of all services provided by its subcontractors.

38. What bill review software or systems are currently in use?

Response: EOEEA currently utilizes the CorVel portal for medical bill review services.

39. Please provide historical annual medical bill review volumes, including: o Number of bills reviewed o Number of providers reimbursed o Annual medical spend o Average monthly transaction volume

Response: During the most recent fiscal year, EOEEA processed approximately 259 or more medical bill reviews. Detailed historical data regarding the number of providers reimbursed, annual medical spend, and average monthly transaction volume is not available at this time.

40. What are the expected savings targets for medical bill review and PPO repricing?

Response: EOEEA has not established a specific percentage savings target. Medical bills are expected to be reviewed and reimbursed in accordance with the applicable Massachusetts fee schedules and requirements.

41. Does EOEEA currently have a preferred PPO network?

Response: No. EOEEA does not currently have a preferred PPO network.

42. Please provide historical annual nurse case management volumes, including average duration of engagement per case. What is the average duration of nurse case management assignments?

Response: Not applicable. EOEEA has not historically utilized nurse case management services; therefore, historical utilization volumes and average assignment duration are not available.

43. Please provide historical annual utilization review volumes, including prospective, concurrent, and retrospective reviews.

Response: EOEEA has historically conducted approximately 50 or more utilization reviews annually. A breakdown by prospective, concurrent, and retrospective review type is not available.

44. Would you be open to bids for straight IRO services that does not include nurse case management first level part?

Response: No. Proposals must address all required services identified in the RFR, including the applicable nurse case management services.

45. For Drug UR you looking IRO?

Response: Yes. EOEEA is seeking Independent Review Organization (IRO) services for Drug Utilization Review (Drug UR).

46. Does EOEEA currently have an electronic claims management system?

Response: Yes. EOEEA currently utilizes an electronic claims management system through its existing vendor, CorVel.

47. Please identify all current systems that will require integration with the Contractor's platform, including any claims management, payment, or document management systems. Please provide additional detail regarding the required API, EDI, SFTP, and data exchange capabilities, including expected transaction volumes and technical specifications.

Response: Not applicable. EOEEA is not requiring integration with its current vendor’s systems as part of this procurement.

48. Is the secure API requirement mandatory at contract commencement, or may integration activities occur during an agreed-upon implementation period?

Response: The implementation timeframe for any required system integration may be negotiated with the awarded Contractor and established during the contract implementation process.

49. What file formats are used for electronic records exchange?

Response: Electronic records are generally exchanged using commonly supported Microsoft Office file formats and PDF, as applicable.

50. Is SFTP sufficient or is API integration mandatory?

Response: Yes. SFTP is an acceptable method for secure electronic data and file exchange; API integration is not mandatory.

51. Approximately how many EOEEA users will require access to the Contractor's portal and reporting tools?

Response: Approximately 3–5 EOEEA users are anticipated to require access to the Contractor’s portal and reporting tools.

52. How should bidders price managed care services such as bill review, utilization review, and nurse case management since pricing tables appear focused primarily on IMEs?

Response: For services not specifically identified in the pricing table, bidders must provide proposed pricing separately in their Cost Proposal. Pricing should be clearly itemized by service, including, but not limited to, medical bill review, utilization review, and nurse case management.

53. Are bidders expected to provide separate pricing for telehealth examinations?

Response: Yes. Bidders should provide separate proposed pricing for telehealth examinations, where applicable.

54. How should travel expenses for remote provider locations be handled?

Response: Any anticipated travel expenses associated with remote provider locations must be clearly identified in the bidder’s Cost Proposal. Travel expenses not identified and approved in advance will not be separately reimbursed.

55. Are deposition minimums or travel charges allowable?

Response: Bidders may propose deposition minimums and applicable travel charges as part of their Cost Proposal. Any such charges must be clearly identified and are subject to EOEEA review and approval prior to incurrence.

56. Is there a standard reimbursement methodology for diagnostic testing coordination?

Response: No standard reimbursement methodology has been established for diagnostic testing coordination. Bidders should clearly identify their proposed pricing methodology for this service in their Cost Proposal.

57. What specific performance standards and penalties will apply beyond the 20% reduction for late IME reports?

Response: In addition to the 20% fee reduction for an IME report not returned within the required timeframe, Contractors are expected to comply with all performance standards and service requirements established in the RFR. Failure to comply may result in non-payment for services and/or removal from the approved vendor list, as applicable.

58. Who is the current incumbent contractor(s)?

Response: The current incumbent contractors are Scope Medical, LLC for Independent Medical Evaluation (IME) services and CorVel for medical cost containment and managed care services.

59. What portions of the current contract scope are currently being performed?

Response: Under the current service arrangements, CorVel provides IME, utilization review, and medical bill review services. Scope Medical, LLC provides IME services only.

60. What is EOEEA's anticipated implementation and transition timeline following contract award?

Response: Please refer to the Procurement Calendar for the anticipated contract award, implementation, and contract start dates. Any additional transition activities and timelines will be coordinated with the awarded Contractor(s), as applicable.

61. Would you consider extending the proposal due date by 1 to 2 weeks to allow sufficient time for respondents to incorporate the answers to submitted questions and prepare a comprehensive proposal?

Response: Yes. EOEEA will extend the proposal submission deadline by two (2) weeks.

Please refer to the revised Procurement Calendar included in this Addendum for the updated proposal due date.

62. Can you share how this contract different from the IME requests that fall under the Mass Workers' Comp?

Response: This procurement is separate from the Commonwealth’s traditional Workers’ Compensation program governed by M.G.L. Chapter 152. This contract will include services for Massachusetts Environmental Police officers with work-related injuries who are covered under M.G.L. Chapter 21A, Section 10J. The contract may also include medical reviews, examinations, and related services for employees involving non-work-related circumstances, as specified by EOEEA.

63. We offer a robust IME network and would be opening to partnering with other companies on other components required under this contract. Will you be sharing a listing of those interested in teaming/subcontracting?

Response: EOEEA does not maintain a list of vendors specifically seeking teaming or subcontracting opportunities for this procurement. However, EOEEA may provide the list of vendors registered in COMMBUYS that received notification of this solicitation.

Inclusion on that list does not indicate that a vendor is interested in or available for teaming or subcontracting opportunities.

END OF ADDENDUM