Workers_Compensation_IDIQ_SOW.pdf

STATEMENT OF WORK

USDA’s Office of Workers’ Compensation Programs Workers’ Compensation Claim Processing and Case Management

Background:

The Federal authority for providing workers’ compensation for injury and illness claims can be found in the Federal Employees’ Compensation Act (FECA), Title 5 or the United States Code, Section 8101-9193 and Title 20 Code of Federal Regulations, 1-25.

The United States Department of Agriculture (USDA) seeks to enter into a Department-wide Indefinite Delivery Indefinite Quantity (IDIQ) contract with an effective technical and professional services provider for the delivery of timely and efficient processing and managing of Office of Workers’ Compensation Programs (OWCP) claims. Such services will address potential deficiencies in the workers’ compensation program, often associated with significant costs, time loss from work and the delinquency of returning recovered employees back to work. The first Task Order (TO) will be for direct support to the USDA’s Farm and Foreign Agricultural Service, however, additional TOs may be issued, as required, in support of other USDA agencies, which include the following:

• Forest Service (FS)

• Rural Development (RD)

• Farm Service Agency (FSA)

• Risk Management Agency (RMA)

• Economic Research Service (ERS)

• Foreign Agricultural Service (FAS)

• National Agricultural Library (NAL)

• Agricultural Research Service (ARS)

• Agricultural marketing Service (AMS)

• Food Safety and Inspection Services (FSIS)

• National Agricultural Statistics Service (NASS)

• National Resources Conservation Service (NRCS)

• National Institute of Food and Agriculture (NIFA)

• Center for Nutrition Policy and Promotion (CNPP)

• Animal and Plant Health Inspection Service (APHIS)

• Grain Inspection, Packers and Stockyards Administration (GIPSA)

Scope of Work:

For each TO, the Contractor shall serve as a liaison between the identified USDA agency and the Department of Labor (DOL) on a day-to-day basis in processing workers compensation claims. TOs on the IDIQ will be made on an agency basis as the need arises. For each TO issued, the contractors principal duties involve: providing the necessary reports and information concerning workers compensation claims provided by the cognizant USDA agency in reviewing and managing long term cases, and establishing a center and system for claims processing and case management for new and existing workers’ compensation cases. The Contractor will initiate and implement appropriate follow-up actions on all new claimants as well as USDA agency claimants’ currently on the periodic or continuing rolls. For each TO issued, the objectives will be to:

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1. Reduce or limit the total costs to the Department arising from the workers compensation program;

2. Ensure that claims are processed and submitted within the timeframes established by

United States Department of Labor (DOL), Office of Workers’ Compensation Programs (OWCP) administered under the Federal Employees’ Compensation Act

(FECA);

3. Submit the claims to the OWCP via electronic transfer;

4. Maintain DOL requirements and licensing for electronic transfer of claims;

5. Continual update of database and electronic requirements to maintain electronic transfer of claims to DOL at all times;

6. Increase the effectiveness of claims administration by ensuring that sufficient information is provided to DOL for proper adjudication of claims;

7. Establish and maintain aggressive claims monitoring, including contacting the employee, the physician, and conducting follow-up reviews, where appropriate;

8. Expedite the return of employees to full or partial duty status or retirement with the cooperation of the agency management;

9. Work cooperatively with DOL, providing them with copies of all new material obtained by the Contractor on individual Agency cases for their official files, and notifying them of cases where individuals will be offered jobs to return to work, and of cases where possible fraudulent action has taken place.

Customer Service:

The contractor shall provide management support in offering technical day to day case management workers’ compensation program services for USDA’s national headquarters and state office locations and employee workforce. Case management support shall include:

• To review all OWCP case file claims e.g. CA-1, CA-2, CA2 or related supportive case information or forms.

• To review any medical, administrative, and financial documentation received which may identify deficiencies, errors, or mistakes that delay proper claims submission.

• To expedite and coordinate claims and input correct codes, addresses, dates, etc.

• To coordinate with the Contracting Officer's duly authorized representative, OWCP representative, collateral duty coordinator, supervisor and claimant to promptly move the process of claims submission process.

• To be thorough and accurate in all case files submission to support the successful adjudication of claims.

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Security Requirements:

Contractor Personnel Security Clearance: A disclosure agreement will be required. Contractor should have clearance from DOL to access their electronic transfer system of claims information.

Electronic Case Management System: Establish and/or maintain a claims processing management system as approved by the Department of Labor (DOL). This includes establishing a Memorandum of Understanding with DOL immediately upon award notification. The DOL has an Electronic Data Entry System (EDES) which permits agencies with clearance from DOL to submit injury claims forms by way of IT submission. The contractor will need to request clearance through the DOL to utilize this EDES system through formal channels with the Director of Workers’ Compensation Programs DOL.

Communications:

The Contractor shall attend periodic meetings at the request of the Contracting Officer's duly authorized representative at least quarterly (more often if necessary) to discuss project status, potential problems, and concerns. Any open issues and action items will be documented by the contractor in the form of minutes. The contractor will provide the minutes of the meeting as a deliverable and it is due no later than five business days after the meeting. Additional meetings can be scheduled as needed. The meetings may be by teleconference or require physical presence.

Transition:

The Contractor shall provide a detailed Transition Plan for the Agency to include startup of case management and DOL approval of electronic case management system and memorandum of understanding. Transition timeframe is sixty days from date of award.

The Contractor shall attend post-award meetings with the Agency and DOL representative to discuss various implementation activities.

Case Management:

The Contractor shall provide comprehensive case management of the Agency’s currently active or existing cases and all new workers’ compensation cases. This includes, but is not limited to:

• Create data log and record all new and existing cases

• Create case files for each accident

• Provide record of each case file to Agency representative

• Forward required documentation to the DOL within ten days of entry

1. While the official case file for each claimant is maintained in the OWCP District Offices, the Contractor shall establish and maintain Agency case files for all claims in its own automated claims case management system as approved by the DOL. The Contractor’s case files will include all relevant OWCP forms, medical reports, and correspondence with or from DOL that the Contractor has been able to assemble, including medical and appeal hearing reports and findings. These files will be maintained and made available to the Contracting Officer's duly authorized representative upon request.

2. The Contractor shall appoint a Program Manager to be the primary interface with Agency

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In addition, the Contractor shall notify the Agency of the Center Director as well as the individual case management employees in the Contractor’s organization who will be handling the individual Agency cases on a day to day basis.

3. The Contractor shall ensure that all new claims and their related case data submitted to the DOL are complete, correct and submitted on a timely basis to meet the time frames set up in the FECA regulations. This will be done working with the claimant, the Contracting Officer's duly authorized representative, the supervisor, the medical care provider, and other parties, as necessary. The Contractor's responsibilities shall include a review of the facts surrounding the accident or event leading to the resulting injury and illness, a review of the other substantiating documentation, including the identification of possible third party liability and subrogation possibilities. Where conflicting information or opinions concerning the injury or illness of the claimant exists, the Contractor shall bring awareness to the Contracting Officer's duly authorized representative and the DOL claims examiner.

4. MONITORING COMPENSATION CASES – The Contractor shall monitor all new and existing workers' compensation cases, ability to interface with the injured Agency employee, supervisor, safety personnel, medical personnel, including the claimants' medical care provider, the Contracting Officer's duly authorized representative, the DOL claims examiner, and other Federal employees and organizations as required. Any new information obtained and placed in the Contractor's files will be transmitted to the DOL District office handling the specific case.

5. In addition to processing all new claims, the Contractor shall review all active and open cases at the beginning of the contract and determine what steps need to be taken with each case. The purpose of this initial review is to assess the current condition of each claimant and to help return these employees to duty status as soon as practical, or to find alternative measures to help bring cases to closure and reduce Agency costs. Where appropriate, the Contractor may recommend controvert of COP or recommend to government on cases, challenge of a claim, which is the process of advising DOL that there are doubts about a specific claim. In a controversy or challenge situation, the Contractor shall contact the Contracting Officer's duly authorized representative to develop a plan of action. When required by the Agency, the Contractor shall be responsible for providing a summary of case histories and the identification of major issues found in individual cases or in a summary of several cases or all active cases and provide to the government reports upon request.

A. When the claimant files for formal appeal and the Agency and/or Contractor is notified properly and in a timely manner, the Contractor shall represent the Agency as required, from time to time at an appeal hearing as an observer. The Contractor may also be requested to review transcripts of the hearing and coordinate and prepare Agency comments and additional material to be included in the record of the hearing. If during the course of its monitoring of compensation cases, the Contractor comes across information that indicates that possible fraud has been committed, the Contractor shall notify the Contracting

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Officer's duly authorized representative and OWCP of this fact. In a case of suspected fraud, the Contractor will also notify the appropriate investigative body in the agency or in the Department of Labor and may be requested to conduct additional research and review of the facts of the case to obtain additional data.

B. The Contractor shall initiate and implement appropriate follow-up procedures on the Periodic roll and death roll cases for the Agency on a nationwide basis. These case files will be reviewed initially for the purpose of monitoring the physical and mental condition of each claimant so that a determination can be made whether the individual is able to return to work on either a full time and regular basis or on a light duty basis and what type of future follow-up is necessary in each case.

C. The Contractor shall make periodic contact with all claimants and their medical care providers, to obtain updates on the claimants’ condition whether the Agency claimant is able to return to work or not. All information obtained from these contacts will be inputted into the Contractor’s automated case management system and shared with the responsible DOL District Office and the Contracting Officer's duly authorized representative as necessary.

6. The Contractor shall coordinate the “return-to-work-effort” by contacting the Agency, Contracting Officer's duly authorized representative, the supervisor, or the Human Resources organization, when necessary, to obtain information about the physical requirements of the claimant's duties and the availability of temporary alternative work accommodation when necessary. The Contractor shall also coordinate its efforts with the OWCP nurse case managers and the claims examiners to obtain work releases from the treating care provider as soon as possible. For Agency claimants who have reached maximum medical improvement and are unable to return to their prior position, the Contractor shall initiate appropriate alternative placement and/or retraining efforts with the Contracting Officer's duly authorized representative and DOL claim’s examiner. The Contractor will also request the Contracting Officer's duly authorized representative and other agency officials to assist in the placement of these claimants and other claimants on the periodic roll who can perform limited or restricted duty into suitable positions within the agency.

Electronic Requirements:

The Contractor shall establish and operate a claims processing system for the Agency and as approved by the Department of Labor for interfacing and transmitting accidents, reports, and claims. The Contractor, in coordination with the Contracting Officer's duly authorized representative, will assume full responsibility for existing workers’ compensation files and claims. These files will be transferred to the Contractor and all active cases as well as all new cases after the execution of the contract will be entered into the Contractor’s case management system. The Contractor shall use Government furnished information only in the performance of this contract.

The Contractor’s claims processing center shall serve as the initial point of entry for all Agency employees submitting claims to the OWCP for consideration. The Contractor’s operating process or system shall be designed to facilitate effective monitoring of each Agency claim, responsiveness to requests and questions raised by both employees and Agency management and a source of guidance and forms for the program. It will have the following manual or automated capabilities which permit:

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1. Review of any medical, administrative, and financial documentation received to identify deficiencies;

2. Resolution of these claims documentation deficiencies;

3. Expedited coordination on issues raised on the claims with the Agency claimant, the care provider, the Contracting Officer's duly authorized representative and through the Contracting Officer's duly authorized representative, and the supervisor as needed;

4. Data security that comply with program privacy and confidentiality requirements;

5. With the cooperation of Agency management and the claimant, adherence to DOL-established formats and timeframes as specified in DOL publication CA-810 and other publications, for submission of all information;

6. Accurate and thorough case files which provide audit trails necessary for the successful adjudication of claims;

7. Processing and resolution of leave buyback cases in accordance with current DOL And Agency requirements;

8. A local hotline telephone number to report injuries and answer workers' compensation questions from employees and supervisors, staffed from 8:30 a.m. to 5:00 p.m. (EST), answered within 4 rings by a live person or by electronic answering service when Center staff are unable to personally answer calls; response times for questions must range from an immediate answer to no greater than 24 hours later in providing an answer. The Contractor shall contact an injured employee within 24 hours of receiving notification of the injury.

Contact of the claimant’s supervisor and care provider may also be made depending on the nature of the injury and the facts of each case. Electronic answering service messages will be returned within 4 business hours. The Contractor case managers will provide courteous and professional assistance and support to employees and supervisors when providing advice or responding to questions or following up on injury reports submitted to the Contractor for processing.

Reporting:

Agency will forward information to Contractor within 24 hours of receiving the claim.

1. Transmit all required documents to DOL within ten days of injury.

2. Monthly reports provided to the Contracting Officer's duly authorized representative. These reports will be prepared on a calendar month bases and submitted by the 15th day of the following month. Reports should include summary information that enables management to make key decisions about the direction for the workers’ compensation program. The reports will also provide cost summary estimates of actual and anticipated annualized chargeback cost estimates, when available and appropriate.

3. The Contractor shall provide management statistical informational reports to the Agency as directed by the Contracting Officer's duly authorized representative to meet program and management needs, not to exceed four times per calendar year:

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A. Aggregate data and information on Agency cases concerning the number of cases, the nature of injury or illness, the cause or type of injury or illness, the age of claimants, etc.

B. Aggregated agency-wide data and reports from the Quarterly Chargeback bills, such as total cost of compensation claims for medical, compensation, and death payments; the number of cases by type of injury or illness, by age of the claimant, by date of injury, by occupational code, etc.;

C. Detailed breakdowns of the foregoing information/data by Agency organizational function to show the incidence of injury and illness by major Agency organizations and to facilitate case management.

4. The Contractor’s Project Manager shall discuss the progress of the Workers’ Compensation Program with the Contracting Officer's duly authorized representative monthly and at other times as requested by the Contracting Officer's duly authorized representative. These monthly meetings may be in meetings scheduled by or via telephone conference calls. The monthly meetings will take place on or about the 20th of each month.

5. Quarterly reporting on cases that were found to be fraudulent.

6. The Contractor shall provide the Contracting Officer's duly authorized representative and the Agency procurement office with quarterly reports on the progress of the work conducted under the contract to facilitate the effective and efficient management of the workers' compensation program and administration of the contract.

Quality Requirements/Performance Standards:

Establish a Quality Control Plan (QCP). The Contracting Officer's duly authorized representative will notify the Contractor of concurrence or required modifications to the

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QCP. Make appropriate modifications and provide to the Contracting Officer's duly authorized representative for final concurrence.

In order to provide managers and supervisors with information on their role and responsibilities in the program, the Contractor will work with the Agency Contracting Officer's duly authorized representative and management to issue documentation that announces the new program and the role of the Contractor in the program. Documentation will also be developed to notify all Agency employees about the new program and the centralized processing of new claims under the workers’ compensation program by the contractor. Periodic reminders of the parties’ roles and responsibilities will also be prepared and issued to Agency staff, as needed. Other methods of communication such as posters, brochures, internal and external website pages, etc. may be developed and provided to Agency management and employees for their access and information.

The QCP shall include, but not be limited to, the following:

1. In order to resolve/reduce the number of old cases: such cases will be analyzed and appropriate action will be initiated during the first year.

2. New cases processed timely and handled within all appropriate regulations and rules.

3. Management reports are accurate and submitted timely.

4. Training offered to OWCP Program Manager and OWCP coordinators in the field during the first year of the contract.

5. The Contractor shall assist in the presentation of periodic training programs to supervisors and employees as necessary.

6. Automated claims process is put into effect within the first quarter of the contract period and 98% accessibility is maintained thereafter.

Travel:

The Contractor shall establish cooperative working relationships and open communication with DOL District Office personnel to aid in the timely and accurate processing of claims. Travel to District DOL Offices may be occasionally necessary to review the official file of claimants and to retrieve certain documents that have not been shared with the Agency. The need for these visits will be determined through discussions between the Contracting Officer's duly authorized representative and the Contractor. The Contracting Officer's duly authorized representative will notify OWCP that the Contractor will be the addressee of record for all inquiries and requests for information or data directed to the Agency by DOL. For other than routine correspondence, the Contractor shall coordinate its responses to OWCP with the Contracting Officer's duly authorized representative. Problems which cannot be resolved informally at the DOL District Office level will be reported to the Contracting Officer's duly authorized representative, who will in turn seek resolution.

All travel by contractor personnel on official company business required by this contract shall be performed and reimbursed in accordance with FAR 31.205-46, Travel costs, and only when approved, in advance and via a modification funded and approved by the Contracting Officer.

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Local travel (within 50 mile radius of the contractor’s office) will not be reimbursed and should be included in the price of the contract.

A Travel Expense Voucher is required for each traveler, for each trip.

Deliverables:

• Quality Control Plan

• Notify DOL of suspected fraud

• Report all detected fraud on a quarterly basis

• Provide monthly and quarterly reporting with recording of new and existing cases.

Reporting on Return to Work Efforts.

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