MMRO RFP 3140004550 DISABILITY PROPOSAL REDACTED.pdf

STATE OF MISSISSIPPI

MS PUBLIC EMPLOYEES RETIREMENT

AMENDMENT

RFQ - Formal

VENDOR NO:

VENDOR NAME & ADDRESS:

(To be completed by Vendor)

RESPONSES REQUIRED BY:

Submission Date : 06/01/2026 Submission Time : 16:00:00 EST

RESPONSES OPENED ON:

Opening Date : 00/00/0000 Opening Time : 16:00:00 EST

SUBMIT NON-ELECTRONIC RESPONSE:

TO :

429 MISSISSIPPI STREET

JACKSON MS 39201

US

RFx number : 3140004550 Smart number : 1531-26-R-RFQF-00005 Buyer : Tracy Robertson-day Buyer Phone : (601) 359-2296 Email : TDAY@PERS.MS.GOV

DELIVERY POINT

NOTICE TO VENDOR:

Public Employees' Retirement System of Mississippi is soliciting proposals from qualified organizations for Disability Determination and Disability Appeal Services to augment its disability retirement application and review process by obtaining Medical Board (MB) and disability determination and disability appeal services for the PERS defined benefit plan.

Vendor Telephone Number Title Date

(Typed or printed) Name of Bidder

Signature of Authorized Bidder

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Managed Medical Review Organization, Inc.

44090 W. 12 Mile Rd.

Novi, MI 48377

(866) 516-6676 ext. 141

Erich Kelly

VP, National Sales & Marketing 06/01/2026

Amendment 1 - RFQ #3140004550 - Received and Acknowledged

JMcCarthy Erich Signature

RFx number : 3140004550 Smart number : 1531-26-R-RFQF-00005

Submission Date : 06/01/2026 Opening Date : 00/00/0000

Time : 16:00:00 EST Time : 16:00:00 EST

Item Change Indicator

Product No. / Mfg. Part No.

Description Delivery / Req.date

Qty Unit

# 1

Product Category : 91876 Disability Determine & Appeal Services

1.000 AU

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RFQ #3140004550

Public Employees’ Refirement System of Mississippi

Prepared for: Prepared by:

Managed Medical Review Organizafion, Inc.

REQUEST FOR PROPOSAL FOR DISABILITY

DETERMINATION AND DISABILITY APPEAL SERVICES

429 Mississippi St.

Jackson, MS 39201

44090 W. 12 Mile Rd.

Novi, MI 48377

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COVER LETTER

Managed Medical Review Organization, Inc. (“MMRO”) is pleased to present the enclosed response to the Public

Employees’ Retirement System of Mississippi’s (PERS) Request for Proposal (“RFP”) for Disability Determination and Disability Appeal Services. Throughout our RFP response, MMRO will demonstrate our extensive experience, operational excellence, and overall institutional knowledge in providing PERS with Disability Determination and

Disability Appeal Services that are objective, accurate, and evidenced-based.

The enclosed RFP response demonstrates why MMRO remains the trusted industry leader in providing Disability

Determination and Disability Appeal Services to the public sector retirement system market. Through our pilot program partnership with PERS, MMRO has developed a deep understanding of the operational, clinical, and member service requirements necessary to successfully administer the PERS Disability Determination and

Disability Appeal Services program.

The institutional knowledge gained through collaboratively building and supporting the PERS Disability

Determination and Disability Appeal Services, combined with the strong operational performance, clinical integrity, and responsive services achieved throughout our partnership, uniquely positions MMRO to deliver exceptional Disability Determination and Disability Appeal Services for PERS and its members.

We value the collaborative relationship established with PERS and remain committed to providing objective, timely, and clinically sound recommendations while continuously enhancing service, quality, operational efficiency, and member experience.

We appreciate the opportunity to participate in this competitive procurement process and affirm our commitment to complying fully with all requirements outlined in the RFP. Our organization is prepared and willing to perform all services mandated, in accordance with the scope, specifications, and timelines set forth by PERS of

Mississippi.

By submitting this proposal, MMRO confirms that it is valid for a period of six (6) months following the submission deadline. MMRO also confirms our Good Standing with the Mississippi Secretary of State. We look forward to the opportunity to build on our past successes and further strengthen Disability Determination and Disability Appeal

Services through continued innovation and quality assurance.

All of us at MMRO thank you for your review and consideration of our response to this RFP.

Sincerely, Erich Kelly, Vice President, National Sales and Marketing

LISA GREEN, DEPUTY DIRECTOR, BENEFIT SERVICES

PUBLIC EMPLOYEES' RETIREMENT SYSTEM OF MISSISSIPPI

429 MISSISSIPPI STREET

JACKSON, MS 39201-1005

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Managed Medical Review Organization, Inc. (MMRO)

44090 12 Mile Road – Novi, MI 48377

(ph.) 866.516.6676 ext. 141 (f) 248.262.5969

(e) ekelly@mmroinc.com (w) www.mmroinc.com

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TABLE OF CONTENTS

TECHNICAL RESPONSE

Organization Information 5

IV. Scope of Services 13

V. Implementation Requirements 13

VI. Ongoing Program Requirements 14

A. Minimum Qualifications 14

B. Program Workflow 19

C. Assessments 24

D. Contractor Recommendations 25

VII. Appeals 27

Conclusion 30

EXHIBITS

Exhibit 1: PERS/MMRO Project Plan and Timeline Exhibit 2: MMRO Company Organizational Chart Exhibit 3: PERS Dedicated Program Staffing Model Exhibit 4: MMRO Physician Specialty and Subspecialty Listing Exhibit 5: MMRO Credentialing Policy Exhibit 6: Additional Information Request Letter Exhibit 7: Clinical Case Management Workflow Exhibit 8: Physician Review Workflow Exhibit 9: MMRO Sample QBR Report Exhibit 10: Appointment Notification Letter Exhibit 11: IME/IPE/FCE Workflow Exhibit 12: Sample Physician Reviewer Report – Approval Exhibit 13: Sample Physician Reviewer Report – Denial Exhibit 14: MAP Portal Guide

ATTACHMENTS

Attachment 1: MMRO Fee Schedule Attachment B: PERS Confidentiality Agreement

Attachment C: PERS Cybersecurity Questionnaire

Attachment D: Certifications and Assurances

Attachment E: PERS Release of Bid as Public Record

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MMRO Experience With Public Retirement Systems MMRO has been conducting the requested services in this RFP for over 15 years for the Public Retirement System market, acting as the trailblazer and industry expert in Retirement System disability programs. With our extensive experience and expertise, MMRO is uniquely qualified to provide the requisite services outlined in the Scope of

Work.

Since our inception, we have become the industry leader in managing public-sector disability retirement claims through the ethical and comprehensive application and provision of industry best practices in the disability marketplace.

MMRO currently partners with more than 75 State, County, and Municipal Retirement Systems across the country in providing public sector disability retirement services, which demonstrates our leadership in disability management and our exponential growth throughout the past decade. Various quality and industry organizations have recognized MMROʼs reputation in the public retirement disability sector, including our exceptional business practices and standards.

At MMRO, we are adept at developing and implementing customized clinical and operational solutions that address the unique requirements of each public pension disability retirement program. By combining deep industry knowledge with innovative thinking and a flexible operational platform, we will meet PERSʼ needs, as we have for over 15 years with the largest client roster of state, county, and municipal public retirement systems in the market.

An Experienced Executive Team MMROʼs executive team has more than 120 years of combined experience in the disability industry and has a comprehensive knowledge of public disability benefit programs across the country. They will be responsible for providing leadership and strategic direction to the Disability Determination and Disability Appeal Services program and will be available to your stakeholders to address any questions or concerns as they arise.

Involvement in the Industry MMRO has played an integral role in shaping the public disability retirement industry, and we understand the importance of continuing that leadership role. To this end, we maintain memberships with the following nonprofit associations dedicated to safeguarding the integrity of Public Retirement Systems in the United States and to promoting and protecting the rights and benefits of all present and future members of those systems.

National Association of State Retirement Administrators National Council on Teachers Retirement (NCTR)

California Association of Public Retirement Systems (CALAPRS)

We also maintain an association membership to the Disability Management Employer Coalition (DMEC), the only association dedicated to providing focused education, knowledge, and networking for absence and disability professionals.

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Staying on the Leading Edge As a result of MMROʼs industry knowledge and extensive experience enhancing disability retirement claim programs for public retirement systems, we have been a Subject Matter Expert presenter at virtually all major public sector retirement conferences on industry best practices for disability retirement claim review programs. Recent conference speaking engagements include:

National Association of State Retirement Systems (NASRA)

National Conference on Public Employees Retirement Systems (NCPERS) Michigan Association of Public Employee Retirement Systems (MAPERS)

State Association of County Retirement Systems (SACRS) Mid-Atlantic Plan Sponsors (MAPS)

Michigan Association of Public Employee Retirement Systems (MAPERS) Illinois Retirement Systems Reciprocal Conference

MMRO Services Offered to Public Retirement Systems MMRO prides itself on its ability to uniquely tailor a disability retirement review program that meets our clients’ needs. The service lines we offer to meet these goals include the following:

Pre-Claim Administrative Services: MMRO can manage all aspects of the required disability retirement claim documents, including the disbursement, tracking, follow-up, and receipt of the required claim documents, and any other related documents.

Disability Case Management Services: MMRO offers a case management solution that reduces our clients’ internal burden by having our clinical professionals (Disability Nurse Case Managers) work directly with

Applicants and/or their treating medical professional(s) to gather relevant medical records and ensure a complete and comprehensive disability retirement claim file is assembled. This, in turn, allows for the most accurate clinical conclusion to be reached at the first level of disability retirement claim review.

Disability Physician Review Services: MMRO is known in the public retirement system industry for our accurate, credible, and quality-based disability retirement reviews. We utilize a robust network of experienced and highly qualified Physician Reviewers in virtually all major recognized specialties and sub-specialties, who understand disability retirement claims and their nuances. All MMRO Physician

Reviewers use evidence-based medical criteria as part of the review process. We have the industry’s most stringent credentialing standards and utilize a well-trained team to ensure compliance.

Independent Medical/Psychiatric Evaluation (IME/IPE) Services: MMRO has examining physician access in the most common specialties used in IME/IPEs. These physicians perform in-person physical examinations and psychiatric evaluation services, with resulting analyses tailored to our clients’ unique disability standards. MMRO’s network of healthcare professionals meets strict credentialing and qualification requirements, consistent with URAC credentialing standards.

Vocational Assessment Services: Through a careful analysis of a claimant’s work history, educational background, and physical, psychological, and emotional capabilities, MMRO determines whether an individual has transferable skills. We then explore alternative jobs/vocations the applicant would be qualified for. Our comprehensive assessments save clients time and money by accurately evaluating a claimant’s work capacity and identifying alternative employment opportunities to use in determining whether the applicant does/does not meet the disability standard under review.

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A Small Sampling of Our Public Retirement System Clients Unlike our competitors, the public retirement system market is the only market we serve. We service approximately 75 State, County, and Municipal Retirement System clients throughout the country, completing over 15,000 Public Retirement System claim reviews per year. Provided below is a list of our five (5) largest Public

Retirement System clients (by number of participants served and years of service) for whom we provide substantial services that parallel some or all services requested in this RFP:

OHIO PUBLIC EMPLOYEESʼ RETIREMENT SYSTEM (OPERS)

LENGTH OF PARTNERSHIP: 2010-2021 and 2024 – Present

OPERS is the 12th largest Public Retirement System, and 16th largest retirement system in the United States.

MEMBERSHIP: OPERS serves more than one million past and present Ohio workers. This includes active (working) members, benefit recipients, and former public workers who maintain an account with the system.

VIRGINIA RETIREMENT SYSTEM (VRS)

LENGTH OF PARTNERSHIP: 2018-Present

VRS is the 20th largest public or private pension plan in the United States, and the 44th largest pension plan in the world.

MEMBERSHIP: VRS administers pension and related benefits for more than 677,000 public sector employees, beneficiaries, and retirees at the state, public school, and political subdivision levels.

KENTUCKY PUBLIC PENSIONS AUTHORITY (KPPA)

LENGTH OF PARTNERSHIP: 2020-Present

MEMBERSHIP: KPPA oversees the administration and operation of the personnel and accounting systems for the County Employees Retirement System and the Kentucky Retirement Systems, as well as day-to-day administrative needs of CERS and KRS. KPPA members include over 386,000 active, inactive, and retired state and local government employees, state police officers, and non-teaching staff of local school boards and regional universities.

PUBLIC EMPLOYEE RETIREMENT ASSOCIATION OF MINNESOTA (PERA)

LENGTH OF PARTNERSHIP: 2014-Present

MEMBERSHIP: PERA serves over 250,000 current and former public employees from over

2,000 local units of government throughout the state of Minnesota.

PUBLIC EMPLOYEE RETIREMENT SYSTEM OF IDAHO (PERSI)

LENGTH OF PARTNERSHIP: 2015-Present

MEMBERSHIP: PERSI provides retirement, disability, survivor, and other benefits to more than

135,000 members. Membership is comprised of retirees, beneficiaries, and active public employees working for more than 760 employers across the State of Idaho.

**Additional State Retirement System Client Listing**

MUNICIPAL EMPLOYEESʼ RETIREMENT SYSTEM OF MICHIGAN (MERS)

MINNESOTA STATE RETIREMENT SYSTEM (MSRS)

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WYOMING RETIREMENT SYSTEM (WRS)

MONTANA PUBLIC EMPLOYEE RETIREMENT ADMINISTRATION (MPERA)

PUBLIC SCHOOL AND EDUCATION EMPLOYEE RETIREMENT SYSTEMS OF MISSOURI

(PSRS/PEERS)

OHIO POLICE AND FIRE PENSION FUND (OP&F)

WEST VIRGINIA CONSOLIDATED PUBLIC RETIREMENT BOARD (CPRB)

NEW MEXICO EDUCATIONAL RETIREMENT BOARD (NMERB)

ILLINOIS MUNICIPAL RETIREMENT FUND (IMRF)

STATE EMPLOYEESʼ RETIREMENT SYSTEM OF ILLINOIS (SERS OF ILLINOIS)

MAINE PUBLIC EMPLOYEE RETIREMENT SYSTEM (PERS)

Missouri Local Government Employees Retirement System (LAGERS)

MMRO Training MMRO staff and Physician Reviewers complete a comprehensive orientation and training program on the

Retirement Disability and Case Management Services process and client-specific requirements before assuming assigned roles and responsibilities. Training topics are specific to the assigned job/role responsibilities of the staff and Independent Physician Reviewer, and the requirements set forth in accordance with the clientʼs statutory requirements. MMROʼs Medical Director, Vice President of Clinical Programs, and Clinical Program Manager ensure the training is completed for their assigned personnel. Ongoing training is provided as needed and annually at a minimum to maintain professional competency.

MMRO Certifications MMRO maintains a number of professional certifications to ensure our Public Retirement System clients receive quality, independence, and security when managing the disability retirement program. Provided are the following certifications MMRO maintains:

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URAC Accreditation Unique to the public disability retirement market, MMRO is accredited by URAC, a nationally recognized accreditation body, identified as providing the highest quality standards in healthcare delivery and clinical claims practices. As a URAC-accredited organization, quality monitoring and improvement are integral components of all disability benefit review services provided by MMRO.

Many internal measures have been created and implemented for the purpose of ongoing identification of quality practices and needs.

The URAC accreditation is a model program that requires a continuum of quality improvement policies and procedures. Its purpose is to ensure the highest possible standard in healthcare-related services.

As a URAC-accredited organization, MMRO demonstrates our commitment to quality and accountability and is subject to compliance audits/investigations to ensure that quality, credible, and objective standards are consistently met. We apply URAC standards to every aspect of our work, including:

Credentialing & Qualifications

Conflict of Interest Quality Review and Measure

Quality Management and Control

SOC2, Type II Certification MMROʼs internal control environment is audited annually in accordance with the American Institute of Certified Public Accountants Service Organization Control Standards (SOC2). MMRO receives a

SOC2 Type II report from its outside audit firm focusing on the internal controls at MMRO and our overall IT Security Infrastructure.

Small Business Enterprise Certification (Commitment to Diversity) MMRO is an equal opportunity employer and recruits, hires, trains, and cultivates a diverse workforce. We train our staff upon hire and annually on diversity, inclusion, and civil rights. MMRO proactively seeks to foster a diverse workforce and has a supporting structure built into the companyʼs mission and core values, employee handbook, hiring practices, and overall cultural impact.

Virginia Small Business Certification:

MMRO is certified as a Small Business by the Commonwealth of Virginia Department of

Small Business & Supplier Diversity. MMRO further operates under an Equal Opportunity

Employment Policy, the terms of which it extends to its business relationships with vendors.

Tennessee Small Business Certification:

MMRO is certified as a Small Business Enterprise (SBE) by the State of Tennesseeʼs Governor's

Office of Diversity Business Enterprise (GoDBE).

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Service Philosophy

Intentionally Left Blank

Vision: To revolutionize our industry and disrupt the status quo.

Mission: To exceed our clientʼs expectations with clinically accurate outcomes and service excellence.

Purpose: To put clinical decision making where it belongs, in the hands of independent, qualified, and unbiased medical experts.

Core Values: MMRO C.A.R.E.S.

C – Customer Commitment: We recognize our clients as partners, and strive to provide them with solutions, rooted in service and quality excellence, that work and that we take seriously.

A – Assure Quality: We set the highest standard of quality in all we do, always driving towards what's next, by constantly challenging one another to improve and break new ground.

R – Respect Everyone: We value and honor the strength and diversity of all individuals.

E – Embrace Change: We encourage innovation, adapt to change and we are willing to take risks.

S – Stronger Together: We synergize the collective experiences, varied skills, and unique talents of every team member for the benefit of the clients we serve and our organizationʼs mission.

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HIGHLIGHTS OF THE MMRO AND PERS OF MISSISSIPPI ENGAGEMENT

Collaborative Improvements As part of the short-term pilot program, MMRO served as PERS’ temporary partner in the development, implementation, and operation of Disability Case Management and Medical Board Review services. During this engagement, our teams collaborated on improvements to assist disability applicants with specific requirements and a streamlined process. Our improvements included the following:

Permission to Refer to Medical Board and Explanation of Failure to Apply Before Termination Letters o MMRO, under PERS's guidance, created templates for the Permission to Refer to Medical Board and Explanation of Failure to Apply Before Termination letters to help Applicants meet PERS-specific requirements.

o Creating standardized letter templates for Applicants resulted in Turnaround Time (“TAT”) efficiencies and preventable rework.

Missed Deadline Claim Closure Letter o MMRO, under PERS guidance, created the Missed Deadline Claim Closure Letter, which is sent to

Applicants who missed the deadline date to submit all required claim documents.

Results Summary Through the handling of 34 disability retirement claims during the pilot program, our teams achieved results that significantly enhanced and streamlined the overall Disability Retirement program. Together, we achieved the following:

Efficiency in Timeframes for Medical Board Reviews o 18-day1 average turnaround time from Medical Board referral to Report delivery to PERS.

Access to a network of Physician Specialties and Subspecialties o Out of 34 claims reviewed as part of the pilot program, 11 different specialties matched specifically to the disabling condition(s) under review.

o By using the appropriate specialties and sub-specialties most suitable to the condition(s) under review, a level of expertise was provided that offered a more thorough and comprehensive disability retirement determination.

Quality Outcomes o The number one operational quality indicator MMRO uses to identify quality improvement opportunities is First Pass Yield (FPY). This metric identifies Medical Board Reports requiring revision due to clinical, compliance, or administrative error.

o 100% First Pass Yield / 0% deferrals for Independent Medical/Psychiatric Examinations (IME/IPE)

Excellence in Member Experience o MMRO’s dedicated Claims Liaisons (CL) and Disability Nurse Case Managers (DNCM) assisted members with navigating the complex disability claims process, answering questions and providing support, increasing member satisfaction through confidence in the process and in the people managing the process.

Cost Effectiveness o During the pilot program requiring review of 34 claims, MMRO did not refer to an Independent

Medical/Psychiatric Examination (IME/IPE) due to the utilization of specialty-matched Physicians and Case Management services. Given the level of specialty and sub-specialty expertise used, zero IME/IPE deferrals were necessary for the 34 cases reviewed by MMRO.

1 All Turnaround Time (“TAT”) references by MMRO throughout this document are listed in Calendar Days

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These results were achieved through the following:

Utilization of a clinically driven workflow process o Disability Nurse Case Managers (DNCMs) working side-by-side with Claims Liaisons (CLs) to ensure a complete and comprehensive disability claim file is referred to the Medical Board.

Applying evidence-based disability guidelines and industry-best practices o Clinical practice guidelines and evidence-based, peer-reviewed literature are applied and referenced for each disability claim.

Instituting a multi-layer claims process o Each PERS disability claim underwent a three-tiered disability claim review, which consisted of Pre-Claim Administration, Clinical Case Management, and Medical Board Review

Utilizing experienced and fully credentialed medical professionals throughout all stages of the Medical Board Review process o All medical professionals, as part of the Medical Board, are credentialed according to the Utilization Review Accreditation Commissionʼs (URAC) standards.

The Creation of a Disability Report Questions Matrix uniquely tailored to the PERS Disability Standard o Recommendation reports presented clinical analyses in a consistent and legally compliant manner.

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IV. SCOPE OF SERVICES

MMRO has reviewed in full the Scope of Services per Section IV of the RFP. As set forth in this RFP response, MMRO is bidding on all services, including Disability Determination and Disability Appeal Services. As set forth in the

Work Plan in accordance with the Scope of Services (see Section VI, Ongoing Program Requirements), all components of the services can be fulfilled by MMRO, and there are no service exclusions.

V. IMPLEMENTATION REQUIREMENTS

PERS intends for the Contractor to lead the implementation process with a single project manager and provide an account manager (single point of contact) once service begins.

During the implementation, the Contractor will work with PERS to review program details and configure a web-based portal to manage communication and real-time status regarding claims. The portal shall allow PERS the ability to request data to gain visibility regarding pending, approved, denied, and closed disability claims. PERS will remain the system-of-record for applicants. The Contractor's web-based portal will meet PERS technology and security requirements (see Attachment C - Independent Medical Reviewer Cybersecurity & Privacy Practices

Questionnaire) and ensure HIPAA compliance.

Where paper forms are necessary, PERS intends for the Contractor to coordinate the development of approved forms and documents with joint logos to make it clear to applicants that the Contractor is working for PERS.

Throughout our business partnerships with many like-sized Public Retirement Systems, MMRO has worked alongside our partners to build, execute, and improve upon the current Disability Management practices of their respective disability claim review programs. Together, we have drafted each process document and developed each workflow that supports every service element of the respective program. MMRO will participate in and lead initiatives related to program development, process change, document creation, technical and system development, and program performance, among other ongoing program administration requirements.

MMRO will lead implementation using a single, dedicated Project Manager who will serve as the primary day-to-day lead throughout planning, configuration, testing, training, and go-live. Upon service commencement, MMRO will transition PERS to a designated Account Manager who will serve as the single point of contact for ongoing operations, performance reporting, issue escalation, and continuous improvement.

During implementation, MMRO will partner with PERS to validate program requirements and configure MMRO’s secure, web-based portal to support communication and provide real-time claim status visibility. MMRO’s portal

(MMRO ACCESS POINT (MAP)) will enable PERS-authorized users to view data regarding disability claim status

(e.g., approved, denied, deferred, and closed), track key workflow milestones, and support secure exchange of disability claim-related correspondence and documentation. PERS will remain the system-of-record for applicants; MMRO will maintain portal data consistent with the approved workflow and provide exports or reports as requested to support PERS oversight and reconciliation.

MMRO meets or exceeds PERS technology and security requirements. Please see Attachment C (Independent

Medical Reviewer Cybersecurity & Privacy Practices Questionnaire). MMRO will maintain HIPAA-compliant administrative, technical, and physical safeguards. MMRO will work with PERS to confirm access controls, authentication, encryption, audit logging, and data retention standards prior to go-live.

Where paper forms are necessary, MMRO will coordinate with PERS to develop, review, and finalize all required forms, templates, and applicant-facing communications. MMRO will incorporate jointly approved co-branding

(including joint logos and standard language), so it is clear to applicants that MMRO is acting on behalf of PERS, and we will maintain version control and a formal approval process prior to use.

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MMRO’s service delivery timeframes for the efforts required to develop, implement, and onboard the requisite services of the Disability Determination and Disability Appeal Services program will be approximately 2- 4 weeks from the initiation of the implementation project plan. Once implementation is complete, MMRO will initiate an additional monitoring period of three (3) months to ensure all aspects of PERS’ Disability Determination and

Disability Appeal Services program are functioning effectively. The best professional partnerships are built on visibility, accountability, and intelligence sharing. MMRO understands these core principles are pivotal to our successful business relationship with PERS. Please see Exhibit 1: PERS/MMRO Project Plan and Timeline, which illustrates how MMRO will implement the services under the contract.

Exhibit 1: PERS/MMRO Project Plan and Timeline

VI. ONGOING PROGRAM REQUIREMENTS

A. Minimum Qualifications

In order to provide defensible disability claim recommendations, it is critical that Contractor's staff meet minimum requirements for education and training, work experience, medical specializations, licenses, and credentials. Contractor must be able to provide documentation of licensure and/or board certification of physicians and nurses.

Physicians must:

Be current non-restricted license or certification as a Medical Doctor for clinical practice from a state in the United States

Be board certified by a medical specialty board approved by the American Board of Medical Specialties

(ABMS)

Have professional experience to include five (5) years' full-time experience providing direct clinical care to patients

Nurses must have:

Unrestricted RN licensure, without sanctions, to practice in a state within the United States

A bachelor's degree in nursing or health-related field

A minimum of five (5) years' clinical experience

Claims liaisons must have:

Minimum of three (3) years' experience in general or claims work in which telephone communication was a primary responsibility

Be proficient in MS Word and Excel

A high school diploma

Contractor will notify PERS, within five (5) business days of reassignment, extended absence or termination, and proposed replacement of key Contractor personnel.

YOUR MMRO TEAM

At MMRO, our biggest differentiator is our people, or as we like to call them, your PERS team. From day one, we established our organization with highly qualified, highly experienced, exceptionally dedicated people. This is true of our internal team and the many outside experts we partner with daily.

To be an effective partner and provide the highest possible level of support to PERS and your members, we require exceptional operations management. That means we make sure everything runs smoothly and everyone works together. To achieve that, we methodically manage, monitor, and measure every aspect of our organization—from the people we hire to the processes we put in place, to the services we deliver.

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MMRO employs a staff of highly trained and credentialed professionals with extensive experience in disability retirement service programs. MMRO’s staff and consultants are selected based on their knowledge, experience, and credentials, and undergo a comprehensive training and orientation program and ongoing process, skills, and communications education. MMRO’s organizational structure includes dedicated operational teams assigned to PERS. This unique organizational structure allows for a greater level of flexible, customized services.

MMRO EXECUTIVE LEADERSHIP

Jennifer Mongeau, DHA, MBA, MSN, RN, Vice President of Clinical Programs Responsible for identifying, developing, and implementing clinical programmatic opportunities for MMRO.

MMRO's VP of Clinical Programs is involved in strategic corporate decision-making and is responsible for developing, implementing, maintaining, and reporting on identified Quality Management Programs.

Douglas Minke, JD, MBA, Vice President Corporate Development/General Counsel Responsible for the leadership, management, and vision necessary to ensure MMRO has the proper operational controls, administrative and reporting procedures, and personnel systems in place to effectively grow MMRO and ensure financial strength and operating efficiency. Mr. Minke also oversees the company’s legal, compliance, and regulatory issues.

Michele Brezinski, MD, Associate Medical Director Responsible for working closely with our Quality Department and Clinical Operations to oversee its Physician

Panel Health Program, which includes the onboarding, training, and remediation of physician reviewers to ensure reviewers are provided with the information and feedback necessary to perform their roles and adhere to Federal and State guidelines and URAC standards for independent medical review.

Erich Kelly, Vice President, National Sales and Marketing Responsible for providing leadership and sales strategies, plans, programs, and functions that are most effective for the company. Aside from deploying plans to meet organizational objectives, Erich coordinates client accounts, oversees new implementation projects, and works with all stakeholders to develop long-term client support and programmatic success.

MMRO DEDICATED PROGRAM STAFFING FOR PERS

MMRO will provide PERS with a dedicated team designed to ensure stability, consistency, and continuity across

Disability Determination and Disability Appeal Services. This staffing model establishes clear accountability, specialized expertise, and responsive program support. In total, the model includes approximately 10 dedicated

MMRO team members across the following roles:

Clinical Program Manager

Disability Nurse Case Managers (DNCM)

Claims Liaisons (CL)

Disability Review Specialist (DRS)

Medical Records Specialist (MRS)

Quality Nurse Reviewer (QNR), Evaluation Services

Medical Evaluation Coordinators (MEC), Evaluation Services

The information below outlines the minimum experience, credentials, education, and certification requirements for each dedicated staff position supporting the Disability Determination and Disability Appeal Services program.

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Roles and Responsibilities of Your MMRO Dedicated Team

Clinical Program Manager

The Clinical Program Manager serves as a senior leader dedicated to overseeing the clinical and administrative professionals supporting the PERS Disability Determination and Disability Appeal Services program. This role is responsible for partnering closely with program leadership to maintain operational efficiency, accuracy, staff oversight, training, and quality management across the PERS programs.

Title: Clinical Program Manager

Experience:

Minimum of seven (7) years of management or leadership experience in a fast-paced clinical, case management, or medical claims environment (e.g., disability, auto, healthcare, or workers’ compensation).

Working knowledge of diagnostic coding, including ICD-10.

Proficiency in analyzing medical information and claims documentation.

Strong critical thinking and decision-making skills.

Exceptional attention to detail.

Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

Credentials:

Unrestricted RN licensure, without sanctions, to practice in the United States.

Education:

Bachelor’s degree in nursing or in a related field such as Health Administration or Business

Management.

Disability Nurse Case Managers (DNCM)

Disability Nurse Case Managers are responsible for overseeing and completing assigned disability claims to support sound clinical decision-making using all applicable information obtained during the claim review process.

This role helps ensure that disability claim reviews are conducted efficiently, thoroughly, and within required timelines.

Title: Disability Nurse Case Manager (DNCM)

Minimum of five (5) years of clinical experience.

Working knowledge of diagnostic coding, including ICD-10.

Strong critical thinking skills.

Strong decision-making skills.

Exceptional attention to detail.

Ability to work independently as well as collaboratively within a team environment.

Credentials:

Unrestricted RN licensure, without sanctions, to practice in the United States.

Education:

Bachelor’s degree in nursing.

Disability Review Specialist The Disability Review Specialist is responsible for coordinating all aspects of the Physician Review process, from claim initiation through final determination.

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Title: Disability Review Specialist (DRS)

At least two (2) years of experience in general office responsibilities and procedures.

Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

High school diploma or equivalent.

Medical Records Specialist The Medical Records Specialist prepares each medical claim file for Physician Review by organizing, indexing, and validating supporting claim documentation.

Title: Medical Records Specialist (MRS)

At least two (2) years of experience in general office responsibilities and procedures.

Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

Claims Liaisons (CL) Claims Liaisons provide administrative oversight and coordination for the PERS programs, including Disability

Determination and Disability Appeal Services. Key responsibilities include retrieving disability retirement applications, initiating the administrative review process, conducting telephonic outreach to explain the claim review process, setting timeframe expectations, answering member questions, assisting members with required documentation, managing correspondence, tracking case status, and supporting other case administration activities.

Title: Claims Liaison (CL)

At least two (2) years of experience in general office responsibilities and procedures.

Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

Quality Nurse Reviewer (QNR), Evaluation Services The Quality Nurse Reviewer is responsible for ensuring the quality of Medical Assessment and Vocational

Assessment reports, including IME/IPE and Vocational Assessment reports. This role participates in the quality review process, quality improvement initiatives, physician orientation, and corporate education programs, with responsibility for clinical correlation, sound medical reasoning, compliance with disability standards, and the overall grammar and formatting of reviewed reports.

Title: Quality Nurse Reviewer (QNR)

Minimum of five (5) years of clinical experience.

Working knowledge of diagnostic coding, including ICD-10.

Strong critical thinking skills in a clinical or healthcare setting.

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Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Credentials:

Unrestricted RN licensure, without sanctions, to practice in the United States.

Bachelor’s degree in nursing.

Medical Evaluation Coordinators (MEC), Evaluation Services Medical Evaluation Coordinators are responsible for coordinating IME, IPE, and FCE services (“Evaluation

Services”). From case intake through final report submission, this role manages scheduling and coordination activities, including communication with members to accommodate appointment needs, arranging evaluations with the medical specialties designated by MMRO clinical staff, and helping ensure timely and accurate completion of Evaluation Services.

Title: Medical Evaluation Coordinator (MEC)

Minimum of two (2) years of related experience in IME, Peer Review, FCE, or a similar scheduling function.

Minimum of two (2) years of experience in a clinical or healthcare setting, or equivalent experience, involving licensed provider selection and/or credentialing.

Excellent verbal and written communication skills, with the ability to work collaboratively with clients, colleagues, and medical providers.

Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Education:

High school diploma or higher.

These team members will be dedicated to the respective PERS programs and committed to delivering a high standard of service and quality. Please refer to Exhibit 3: PERS Dedicated Program Staffing Model.

Exhibit 2: MMRO Company Organizational Chart

Exhibit 3: PERS Dedicated Program Staffing Model

A NETWORK OF PHYSICIAN REVIEWER SPECIALISTS

MMRO utilizes an extensive network of specialists and subspecialists. MMRO’s nationwide network of Physician

Reviewers comprises over 325 physician specialists, in virtually all major specialties and sub-specialties. Our dedicated credentialing team ensures that our Physician Reviewers meet the qualifications set by URAC (board-certified, actively practicing, no conflicts of interest, etc.). With more than 15 years of experience working with

Public Retirement Systems, MMRO has a distinct advantage when it comes to physician orientation and training.

Our Physician Reviewers are assigned to cases in the specialty and/or subspecialties most suitable to the eligible disabling diagnosis(es) of the initial disability retirement claim application or annual review. Physician Reviewers will be required to review medical and claim information and documentation in connection with a disability retirement application or annual review and provide a written report for each review performed. Please see

Exhibit 4: MMRO Physician Specialty and Subspecialty Listing for a comprehensive listing of our Physician

Specialties and Subspecialties.

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MMRO Credentialing Standards

MMRO imposes stringent credentialing standards for our Physician Reviewers and other licensed medical specialists involved in the services provided. Our well-trained credentialing team ensures our Physician Reviewer network includes only qualified physician specialists and sub-specialists who provide unbiased, accurate, and credible disability retirement claim reviews using evidence-based medical criteria to further support final disability determinations.

MMRO maintains a credentialing process to ensure that Physician Reviewers and other licensed medical specialists have valid credentials while performing disability claim review services. The credentialing process establishes selection criteria for physicians and other health professionals to be a part of the MMRO network. No

Reviewer will be assigned a case until they have passed credentialing or are in the process of being re-credentialed, as necessary.

MMRO’s corporate policies and procedures acknowledge our obligation to a Retirement System client for an ongoing and frequent credentialing program. All Physician Reviewers are required to maintain valid licensure and credentials during their tenure with MMRO, including meeting the continuing education requirements, if required, of their license or board certification. Please see Exhibit 5: MMRO Credentialing Policy.

Requirements & Qualifications of the Medical Board Panel Physicians

Current non-restricted license or certification as a Medical Doctor or Osteopathic Doctor for clinical practice.

Board Certification and/or subspecialty certification by a medical specialty board approved by the

American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA), American Board of Podiatric Surgery (ABPS), American Board of Podiatric Orthopedics and Primary Podiatric Medicine

(ABPOPPM), or American Board of Professional Psychology (ABPP)

Professional experience to include five (5) years’ full-time experience providing direct clinical care to patients

No history of sanctions or disciplinary actions

MMRO confirms it will notify PERS, within five (5) business days of reassignment, extended absence or termination, and proposed replacement of key Contractor personnel.

B. Program Workflow

These are the high-level requirements of the PERS disability review program:

1. Application: PERS collects a disability application (packet) from applicants, completes an audited estimate of benefits and uploads the packet and estimate to the Contractor's web-based portal.

2. Outreach to applicants:

Within two (2) business days of receiving a benefit application and required claim documentation

(packet), the Contractor will make an initial outreach to the applicant to describe the process, confirm contact information for provider(s), explain expected timeframes, and confirm applicant and Contractor contact information.

Contractor will notify PERS if Contractor becomes aware of Applicant or Recipient address and/or contact information changes.

3. Clinical triage:

Within 21 calendar days of receipt of application or request for assessment, the Contractor will complete all outreach attempts to the applicant; attending physician(s); ancillary care provider(s);

and employer, if applicable. During the outreach attempts, if information from the application or

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Contractor will triage (categorize/prioritize) the claim path

4. Disability claims categories and workflow:

Based on the disability claim category/priority (to be determined and finalized by PERS and

Contractor during implementation), the Contractor will establish the appropriate review plan, including timelines for subsequent activities so that timeliness of activity can be assessed.

5. Periodic reviews of continued eligibility:

PERS has the right to review benefit Recipients' disability status on a periodic basis, typically on an annual basis or when the initial provider's information provides guidance on when the disabling condition may change. The Periodic Review can also be conducted to confirm continued treatment, typically on an annual basis. The Periodic Review may include whatever clinical review activities are appropriate to the Recipient's circumstance, including Medical and/or Vocational Assessments.

Contractor, when requested by PERS, will establish a follow-up plan for each approved disability application and periodic review, including the frequency of (annual for five years, every three years thereafter, or discontinued if circumstances warrant), and nature of information required.

6. Escalations:

Contractor will escalate cases of non-compliant applicants and non-compliant recipients

(undergoing a medical review) to PERS within one (1) business day of non-compliance.

7. Changes in claim status:

Contractor will notify PERS within one (1) business day of notification if there is a change in the status of an Applicant or Recipient, by:

i. Death

ii. Return to work of any type (including volunteer work). Contractor will contact PERS if it is discovered that the Applicant/Recipient has returned to work or intends to return to work.

iii. Withdrawing claim

8. Contractor will prepare and provide quarterly reports of claim activity.

Through our partnership with PERS, MMRO has developed a deep understanding of the operational, clinical, and member service requirements necessary to successfully administer the Disability Determination and

Disability Appeal Services program.

As set forth below, MMROʼs proposed Disability Determination and Disability Appeal Services process will serve to build on the results achieved through our partnership with PERS, and continue to meet PERSʼs operational and legal requirements while focusing on:

Industry-based practices

Utilizing clinically driven workflow processes

Applying evidence-based disability guidelines

Instituting a multi-layer claims process, and

Utilizing experienced and fully credentialed clinical staff throughout all stages of the disability retirement claim review process.

How the Process Works: Case Management of New Disability Applications

MMRO proposes the following service components for the Case Management of New Disability Claim

Applications to accomplish PERS’ overarching goal of ensuring that disability retirement claim files are complete and comprehensive, further ensuring a fair and equitable claim process for PERS’ members.

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Claim Initiation: Upon receipt of a new application (disability packet – DSBL 1-10 (DSBL 11, only if specifically requested)) through our secure web-based portal (MMRO ACCESS POINT (MAP)) from PERS staff, MMRO begins an initial review of the new disability application.

Initial Outreach to Applicants: Upon receipt of a benefit application and required claim documentation

(packet), MMRO’s Claims Liaison (“CL”) will conduct an outreach to the disability applicant (PERS member) to assure the applicant that MMRO is in receipt of their request to file a disability retirement claim, and to set expectations for the disability retirement claim process (i.e., turnaround time, what to expect, answer any questions from the applicant, provide contact information, etc.). MMRO will notify PERS if MMRO becomes aware of the Applicant or Recipient address and/or contact information changes. The new contact information will also be updated within MMRO’s secure web-based portal (MAP).

Clinical Review: Upon receipt of the application, the disability retirement claim file will be assigned to a PERS-dedicated Disability Nurse Case Manager (“DNCM”). The DNCM will thoroughly review the submitted disability retirement claim file to determine whether the clinical claim documents submitted with the application are complete and ready for Physician Review. If the DNCM determines that the disability retirement claim medical records are complete, the DNCM will refer the claim to the Physician Reviewer.