Att O-Scope of Work.docx

SCOPE OF WORK

RFP 26-87343

Medical Consultation Services for the Disability Determination Bureau

A. The Contractor shall provide the following services relative to this Contract:

1. The Contractor shall provide medical consultation services for Social Security Disability claims as directed by the State’s Disability Determination Bureau (DDB) pursuant to Indiana Code 12 9-2-1 et. Seq.

2. The Contractor shall maintain an unrestricted and non-probationary medical license issued by the State of Indiana.

3. The Contractor shall provide the said consultation services employing the Contractor’s knowledge, training, and experience and shall apply the Contractor’s expertise according to the standards set forth in the Social Security Administration’s Program Operations Manual for the Evaluation of Social Security Disability Claims (the “Manual”). The State will provide access to the Manual and other pertinent documents of the Social Security Disability program to the Contractor.

4. The Contractor shall provide said consultation services only at the State’s DDB offices at 2525 N. Shadeland Ave., Indianapolis, Indiana or at a State and Social Security Administration (SSA) approved remote work location, typically the contractor’s residential address. Remote reviews must be performed on SSA equipment and an SSA secured VPN to be provided by the State. Performing remote reviews may or may not be an option dependent upon the needs of the DDB and options provided by SSA. The Contractor must be available to report to the DDB office as required by DDB with minimal notice. The State shall make available to the Contractor office space for the Contractor to review and evaluate case files when necessary. The state will provide a computer to be used in DDB offices and when working in an approved remote work location. The Contractor may not remove any files or copy the paper or electronic files for the purpose of removing them from the DDB office or SSA aegis.

5. The Contractor shall provide said consultation services at such times as the Contractor may decide within the following guidelines: security access to the State’s DDB offices is from 7:00 a.m. to 5:30 pm, local time, Monday through Friday. Remote work can be performed at an approved location at such times as the Contractor may decide so long as system access is available. Access to DCPS and associated SSA systems is typically available 24/7 except when down for maintenance.

6. The Contractor shall complete time and activity reports, or other reports as requested by the State.

7. The Contractor shall determine how many cases the Contractor shall review at any one time, but all cases received by the Contractor must have all actions completed and be returned to the DDB’s workflow of cases within forty-eight (48) hours after receipt. Standards of promptness and workflow assignments shall be determined by the DDB. At the discretion of the DDB, cases may be removed from the Contractor’s queue prior to the Contractor’s completion of work.

8. The Contractor shall maintain all consultation services at 95% accuracy, as demonstrated by the case review and evaluation performed by Social Security Administration. The case review commonly referred to as the Disability Quality Branch (“DQB”) review consists of all levels of cases. Only Group I errors (decision and documentary, not referring to onset) defined as significant medical decision or documentation deficiencies will affect the computation of this accuracy rate.

9. The Contractor shall provide, at the Contractor’s own expense, any supplies required to perform the consultation services beyond the equipment provided by the SSA.

10. The Contractor shall attend, or view, training developed by SSA or DDB. The parties agree that should the Contractor be required to attend training sessions, attendance at each hour of training will be paid at the rate equal to the completion of two (2) cases.

11. The Contractor shall also provide training to the State as agreed upon by the Contractor and the State. The parties agree that should the Contractor provide training, each hour of training provided shall be paid at the rate equal to the completion of two (2) cases.

12. The Contractor shall comply with all State and Federal statutes, rules and regulations and all rules and regulations of the State relative to the review and evaluation of claims for Social Security Disability benefits.

13. The Contractor shall correct any deficient work product at no additional cost beyond the fee for the initial review and evaluation. “Deficient work product” means work not meeting established federal Social Security Administration program standards as set forth in the Social Security Administration’s Program Operations Manual for the Evaluation of Social Security Disability Claims (the “Manual”) or work determined to be inadequate as a result of federal or internal quality assurance review.

14. The Contractor shall pay for any travel or other expenses incurred by the Contractor and not hold the State responsible for such.

B. The State shall have the following duties:

1. The State shall monitor the Contractor’s work and determine whether any work is deficient.

2. The State may from time to time provide information concerning the Social Security Disability program, which may be given at a meeting, and the State may invite the Contractor to attend such meetings. Meetings will be for the purpose of disseminating new information that will be of benefit to the Contractor in the performance of their duties under this Contract. Meetings will occur no more frequently than once per month. The Contractor will not charge the State, and the State will not pay the Contractor, for attendance at these meetings.

3. The State will provide all computer access (at their discretion) necessary for the performance of the Contractor’s duties except for home internet services to allow for remote work.

C. General Provisions:

1. Case(s) not worked to completion may be reassigned to another consultant if the Contractor is not available for consultation services at the State’s premises at 2525 N. Shadeland Avenue or via an approved remote work location. The Contractor shall forfeit the right to payment on a case that is reassigned.

2. There will be cases that the Contractor has worked for which the Contractor will not receive payment. Examples would include but are not limited to: cases in which no form is completed; cases that are transferred out of state; cases that are returned to the District Office with no medical decision; etc.

3. There is no guarantee of any specific number of cases that will be available for review and evaluation by the Contractor. The number and type of cases available for review and evaluation are determined by individuals making application for Social Security Disability benefits, and may vary from time to time. The services herein will not be full-time services. The Contractor shall be free to provide services to others.

4. The Contractor shall receive the cases the Contractor will review and evaluate at a location in said DDB offices to be designated by the State or via approved remote work location. The Contractor has agreed to review cases in the following specialties:

ALL ADULT AND CHILD BODY SYSTEMS EXCEPT MENTAL

5. The contractor shall provide prompt responses to all communications, allowing no more than two business days (48 hours) to elapse before responding to inquiries from the State’s Disability Determination Bureau (DDB).

D. Conflict of Interest

1. The Contractor shall disclose any financial, professional, or referral relationships with consultative examination providers or entities that may benefit from disability determinations. The Contractor shall not solicit claimants or engage in activities that could impair impartiality in case evaluations.

E. Independent Verification & Validation (IV&V)

1. In the event the State determines that any independent verification and validation ("IV&V") oversight is required by the State during the term of this Contract, the Contractor shall comply with any such oversight during the term of this Contract, pursuant to which an independent third-party review may be conducted by a reviewer selected by the State, for the purpose of verifying that the Contractor has performed its obligations in compliance with the terms of this Contract. In the absence of any such IV&V oversight, the Contractor shall comply with any other appropriate methods or means for verification and validation required by the State during the term of this Contract for the purpose of verifying and validating that the Contractor has performed its obligations in compliance with the terms of this Contract. The Contractor shall provide all information and documentation requested during the State's IV&V oversight or verification and validation efforts related to this Contract and in connection with any IV&V oversight or verification and validation efforts related to an initiative of which this Contract is a part.

F. Artificial Intelligence (AI) Use The State of Indiana has adopted an enterprise-level policy governing the use of Artificial Intelligence (AI) within state government. The State of Indiana AI Policy is issued and monitored by the Office of the Chief Data Officer (OCDO), in cooperation with the Chief Privacy Officer (CPO) and the Management Performance Hub (MPH). In complement the AI Policy, the State Agency Artificial Intelligence Systems Standard outlines the rationale behind the AI Readiness Assessment process required for the implementation or any use of AI by a state agency. The standard outlines the requirement for the submission of a Readiness Assessment Questionnaire prior to implementation or use of an AI tool or system. Any proposed solution meeting these requirements must support the State’s AI Policy and follow the AI Readiness Assessment Process. See https://www.in.gov/mph/AI/ for more detailed information.

G. Security, Confidentiality, and Data Ownership

1. The State has robust and comprehensive security standards that permeate all levels of the organization. The Indiana Office of Technology (IOT) has been tasked with establishing and maintaining these security standards. The security standards include assessing security risks, developing, and implementing effective security procedures, and monitoring the effectiveness of those procedures. If the proposed solution involves information technology-related products or services, all such products or services are to be compatible with any of the technology standards found in the Information Security Framework (https://www.in.gov/iot/iot-vendor-engagement/) that are applicable, including the assistive technology standard. Respondents will be required to sign a Non-Disclosure Agreement (NDA) to access the IOT Information Security Framework; Respondent’s should review the IOT Information Security Framework, and ensure their proposed solution meets all standards therein. Confirm that any data provided by or for the State remains State property and may not be marketed or sold by the respondent without the express written State consent.

2. Confirm that any data provided by or for the State remains State property and may not be marketed or sold by the respondent without the express written State consent.

3. Respondent must provide incident response process documentation for their proposed solution, including, at a minimum, contact/ticket submission process, escalation justification and procedures, and reporting of resolved incidents back to IOT (including root causes analysis and lessons learned for large incidents).

H. HIPAA and Protected Health Information (PHI)

1. The Contractor acknowledges that it may receive or access Protected Health Information (PHI) when performing medical chart reviews and related consulting services. The Contractor shall comply with all applicable federal and state privacy and security laws and regulations, including HIPAA and HITECH, and shall use or disclose PHI only as necessary to perform services under this Contract and consistent with SSA program requirements. The Contractor shall implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of PHI and Personally Identifiable Information (PII), and shall limit access to the minimum necessary. In the event of any suspected or actual unauthorized use or disclosure of PHI/PII, the Contractor shall notify the State within 24 hours and cooperate fully in investigation, mitigation, and remedial actions. If required, the parties shall execute a Business Associate Agreement (BAA) in form acceptable to the State.

I. Key Performance Indicators (KPIs)

1. The State will use Key Performance Indicators (KPIs) to measure performance and outcomes of the Contract. The specific KPIs and their targets will be defined and agreed upon by the State and the Contractor during the initial phases of the requirements under the Contract. At a minimum, on time delivery at quality standards of the scope provided within the budget set forth in the Contract will each be measured. Additionally, the State will collect a modified Net Promoter Score from customers to this Contract in its discretion. Low ratings on the modified Net Promoter Score or failure to meet any other KPIs may be deemed, at the discretion of the State, to constitute default under the Contract.

J. End of Contract Turnover / Disengagement

1. The services to be performed under the Contract resulting from this RFP are vital to the State and must be continued without interruption. Procedures must be in place to ensure a seamless transition and uninterrupted service throughout the transition to a project successor at contract end. The State seeks to ensure that program stakeholders experience no adverse impact from the transfer of scope to either the State or to the successor contractor(s) should the Contract not be extended or terminated early.

2. The Contractor shall be responsible for planning and performing end of contract turnover and disengagement activities. Disengagement includes transition planning to ensure a seamless operational transition to the State or its designee in the event of required contract transition. The Contractor shall work with the State to ensure that all end of contract turnover tasks are completed and that all responsibilities are transitioned in a timely and effective manner.

3. The Contractor shall complete, at a minimum, the following tasks and activities during the End of Contract Turnover period:

a) Develop an End of Contract Turnover Plan, subject to State approval, including a detailed schedule and resources (quantity, type, and role) who will be available for all months of the End of Contract Turnover period. The End of Contract Turnover Plan shall outline the following:

b) Contractor roles and responsibilities

c) State roles and responsibilities

d) A schedule with key milestones and deliverables

e) Method to transfer information to the State and/or a successor contractor(s)

f) An inventory of detailed documentation about operations, applications, architecture, and infrastructure, as well as any supporting information related to the technical architecture and infrastructure.

g) An inventory of all work-in-progress that need to be completed by the State and/or a successor contractor(s)

h) Plans for coordination and transition of specific responsibilities from the incumbent to the future contractor.

i) An inventory of project documentation, work-in-progress, technology, systems, and assets necessary for a successive Contractor to perform the duties of the Scope of Work

j) Conduct training of State staff or successor contractor(s) staff, in the operations and procedures performed by Contractor staff.

k) Perform shadowing and training activities for the State and successor contractor(s)

l) Transfer the following information to the State or a successor contractor(s) on a medium acceptable to the State:

m) All relevant project artifacts created, maintained, and updated throughout the Contract term

n) Project documentation, work-in-progress, technology, systems, and assets necessary for a successive Contractor to perform the duties of the Scope of Work

o) Other documentation including, but not limited to:

i. User, provider, and operations manuals

ii. Training materials

iii. Documentation of any interfaces developed to support business activities between contractors

p) Participate in reverse shadowing for the State and/or successor contractor(s) staff on all aspects of workflows, releases, and assignments as requested by the State

q) Be available to provide support as requested by the State by the end date of the Contract