RFP_S23DWC036.pdf

STATE OF CALIFORNIA Gavin Newsom Governor

REQUEST FOR PROPOSAL (SECONDARY METHOD)

Notice to Prospective Proposers RFP No. S23DWC036

August 16, 2024

You are invited to review and respond to this Request for Proposal (RFP) No. S23DWC036, titled INDEPENDENT BILL REVIEW. In submitting your proposal, you must comply with the instructions found herein.

This RFP is published online in the California State Contracts Register (CSCR) at https://caleprocure.ca.gov/pages/index.aspx. To ensure receipt of any addenda to this RFP that may be issued, interested parties are encouraged to register online at:

https://caleprocure.ca.gov.

The Department of Industrial Relation’s (DIR) deadline for receipt of proposals is August 30, 2024, no later than 2:00 p.m. All proposals received late will be rejected. File size cannot exceed 50 Mega Bytes (MB). The naming convention of the proposal must be in the following format: “RFP S23DLSE036 [Insert vendor name] Proposal.” Proposals must be received on or before the date and time specified herein at email addresses provided below:

EMAIL RFP Proposal to:

Procurement@dir.ca.gov CC: magbayani@dir.ca.gov CC: klanterman@dir.ca.gov

You are advised that you are responsible for ensuring that your proposal is received by the above listed contact person by the time and date required. Any proposal reaching the contact person after the deadline date and time will be rejected.

In the opinion of DIR, this RFP is complete and without need of explanation. However, if you have questions, notice any discrepancies or inconsistencies, or need any clarifying information, contact the person listed below. All questions must be submitted in accordance with the RFP instructions contained herein and sent via email directly to the below listed contact person and not through the Cal eProcure system.

Contact: Marian Agbayani Email: magbayani@dir.ca.gov

We appreciate your interest in this project and hope to receive a proposal from you if this is within your area of expertise.

https://caleprocure.ca.gov/pages/index.aspx https://caleprocure.ca.gov/ mailto:Procurement@dir.ca.gov mailto:klanterman@dir.ca.gov

Department of Industrial Relations RFP No. S23DWC036

Table of Contents

SECTION PAGE

I. PURPOSE / BACKGROUND / SCOPE OF WORK 2

A) Purpose 2 B) Background 3 C) Scope of Work 3

II. PROPOSAL REQUIREMENTS (GENERAL) AND INFORMATION 3

A) Key Action Dates 4 B) Questions Regarding RFP Requirements 4 C) General Proposal Requirements 5 D) Submission of Proposals 5 E) Modification and/or Withdrawal of Proposals 6 F) Proposer Responsibilities 6 G) Signature 9 H) Disposition of Proposals 9 I) Socio-Economic and Preference Programs 9

III. PROPOSAL REQUIREMENTS (TECHNICAL) 11

A) Technical Proposal Requirements 11

1) Minimum Qualifications 11

2) Title Page 12

3) Cover Letter / Letter of Commitment 12

4) Table of Contents 13

5) Summary 13

6) Minimum Qualifications Response 13

7) Required Attachments 13

8) References 13

9) Conflict of Interest and Confidentiality Statement 13

10) Subcontracts / Subcontractors 13

11) Technical Portion 14

a. Management Plan 14

b. Methodology (Approach to Work) 14

c. Work Plan and Work Schedule 14

d. Personnel / Experience 15

e. Interview/Presentation 16

f. Page Headers and Page Numbering 16

B) Cost Proposal Requirements 17

1) Cost Detail 17

2) Page Headers and Page Numbering 18

IV. EVALUATION, SELECTION, AND AWARD 18

A) Administrative Evaluation (Phase 1) 18 B) Technical Evaluation (Phase 2) 18

1) Scoring Criterion Guidelines 18

2) Cost Points 19

3) Interview Criteria and Scoring 20

4) Proposal Evaluation Form 21 C) Selection 24 D) Notice of Proposed Award 24 E) Standard Conditions of Service 25

F) Post Award Requirements 25 G) Proposal Rejection 26

ATTACHMENTS 27

1. Attachment 1- Required Attachment Checklist 27

2. Attachment 2- Draft Standard Agreement (STD 213) 28

Exhibit A, Scope of Work 29 Exhibit A, Attachment 1 – Technical Proposal 52 Exhibit B, Budget Detail and Payment Provisions 53 Exhibit B, Attachment 1 – Contractor Cost Sheet 54 Exhibit C, General Terms and Conditions (GTC 04/2017) 55 Exhibit D, Special Terms and Conditions 56 Exhibit E, Additional Provisions 63

Exhibit F, Statement Regarding Confidentiality and Security of DIR Information

Exhibit G, Acknowledgment of Confidentiality 68

3. Attachment 3- Proposer References Form 69

4. Attachment 4- Payee Data Record (STD 204) 70

5. Attachment 5- Contractor Certification Clauses (CCC 04/2017) 72

6. Attachment 6- California Civil Rights Laws Certification 76

7. Attachment 7- Darfur Contracting Act Certification 77

8. Attachment 8- Bidder Declaration 78

9. Attachment 9- CA DVBE Bid Incentive Instructions 80

10. Attachment 10- Contractor Cost Sheet 83

11. Attachment 11-Detailed Response for Minimum Qualifications 84

12. Attachment 12- GenAI Reporting & Fact Sheet Form 85

I. PURPOSE / BACKGROUND / SCOPE OF WORK

A. Purpose

This Request for Proposal (RFP) is to contract with an independent bill review organization (IBRO) to resolve medical billing disputes referred to the IBRO by DWC under Labor Code section 4603.61 and California Code of Regulations, title 8 (8 C.C.R.), section 9792.5.72, et al.

For a detailed description of the work to be performed, please refer to Attachment 2, Draft Standard Agreement. No work shall begin until all required signatures and approvals are obtained and the DIR Project Manager provides direction.

The total budget for the entire contract is $0.00. The services performed under this contract will be billed independently and directly by the selected IBRO to the claims administrator or provider. The IBRO may bill up to $335 per review performed under this contract. Proposals exceeding $335 per review may be deemed non-responsive and ineligible for award.

B. Background

The purpose of the RFP is for the Department of Industrial Relations’ (DIR) Division of Workers’ Compensation (DWC) to contract with an independent bill review organization (IBRO) to resolve medical billing disputes referred to the IBRO by DWC under Labor Code section 4603.63 and California Code of Regulations, title 8 (8 C.C.R.), section 9792.5.74, et al.

On September 18, 2012, Governor Brown signed into law comprehensive workers’ compensation reform legislation, Senate Bill (SB) 863, with the goal of improving access to medical care for injured workers, avoiding delays and disputes, and reducing costs to employers. SB 863, with an effective date of January 1, 2013, adopted several reforms to meet these goals.

A key provision of SB 863 established the Independent Bill Review (IBR) process, administered by DWC, which resolves medical treatment and medical-legal billing disputes regarding the amount to be paid to medical providers. IBR is effective for all dates of services on or after January 1, 2013, and is limited to disputes involving services or goods covered by fee schedules adopted by DWC or contract for reimbursement under Labor Code section 5307.11. IBR will not apply to billing disputes involving services or goods that are not covered under adopted fee schedules, disputes about treatment authorization, or cases where the injury itself is in dispute. The overview for the current IBR process can be found at: http://www.dir.ca.gov/dwc/IBR.htm.

Labor Code section 139.5 requires the administrative director to contract with an IBRO to conduct reviews. Under Labor Code section 4603.6(c), the costs of IBR will be initially advanced by the medical provider and ultimately borne by the “losing” party.

C. Scope of Work

The Contractor shall provide independent bill review services to resolve medical billing disputes .

For a detailed description of the work to be performed, please refer to See Attachment 2, Draft Standard Agreement.

II. PROPOSAL REQUIREMENTS (GENERAL) AND INFORMATION

This section contains instructions for the submission of your proposal. It is the responsibility of the proposer to carefully read and follow all proposal requirements within this RFP.

3 https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=LAB&sectionNum=4603.6.

4 https://www.dir.ca.gov/t8/9792_5_7.html http://www.dir.ca.gov/dwc/IBR.htm https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=LAB&sectionNum=4603.6.

https://www.dir.ca.gov/t8/9792_5_7.html

Compliance with the RFP instructions is mandatory for your proposal to be considered for award. Failure to comply with the RFP instructions may cause your proposal to be deemed non-compliant and non-responsive, thus ineligible for award.

A. Key Action Dates

Below is the tentative time schedule for this RFP. DIR reserves the right to modify the RFP and/or change dates and times at its sole discretion, prior to the date fixed for submission of proposals, by the issuance of an addendum that will be posted on the California State Contracts Register (CSCR) at: https://caleprocure.ca.gov.

1. DIR reserves the right to modify or cancel in whole or any part of this solicitation.

2. Clarifications to the solicitation will only be provided in the form of a written addendum to all Proposers.

Key Action Date Time RFP available to prospective Proposers August 16, 2024 N/A

Written Questions Submittal Deadline Aug.22,2024 2:00 pm Pacific Time

Questions and Answers Addendum Posted August 27, 2024 5:00 pm Pacific Time

Final Date for Proposal Submission/ Receipt by

DIR

August 30,2024 2:00 pm Pacific Time

Complete Evaluation of proposals September 6, 2024 N/A

Interviews September 12 , 2024 3:00 pm Pacific Time

Posting of Intent to Award Notice(s) Notice is posted for five (5) business days

September 16, 2024 N/A

Agreement sent to successful Proposer

September 20, 2024 N/A

Signed Agreement returned to DIR for counter-signature

September 23, 2024 N/A

Agreement Approved and Executed- work begins October 1, 2024 N/A

Dates listed above (or below, depending on page) are estimates only, and subject to change at DIR’s sole discretion. No work shall begin until all required approvals and signatures, including the Department of General Services (DGS) Office of Legal Services, if applicable, are obtained.

B. Questions Regarding RFP Requirements

All questions or concerns related to the RFP requirements must be directed electronically to:

https://caleprocure.ca.gov/

Office of Administrative Services Business Management Office Contact: Marian Agbayani Email: magbayani@dir.ca.gov

Questions must be received by the date and time specified under Section II, A. Key Action Dates. Answers to all questions submitted will be in the form of an addendum posted to the DGS California State Contracts Register (CSCR) website https://caleprocure.ca.gov/pages/index.aspx by the date and time specified under Section II, A. Key Action Dates. Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum to all parties/participants. All questions must be submitted referencing the RFP number in the subject line, directly to the above listed contact person and not through the Cal eProcure system.

C. General Proposal Requirements

1. Proposals should provide straightforward and concise descriptions of the Proposer’s ability to satisfy the requirements of this RFP. The proposal must be complete and accurate. Omissions, inaccuracies or misstatements will be sufficient cause for rejection of a proposal.

2. Proposals must be submitted for the performance of all services described herein.

Any deviation from the work specifications (Section Ill, Proposal Requirements, and Attachment 2, Draft Standard Agreement) may cause a proposal to be rejected.

D. Submission of Proposals

1. Proposals must be submitted no later than the date and time indicated in Section

II.A. Key Action Dates, and must be addressed as follows in Item 2.

Proposals received after this date and time will not be considered and will be rejected.

2. Delivery Instructions

Responses to this RFP shall be submitted to DIR at the following email addresses provided in Section 2.b. below and include:

a. One (1) copy containing the Technical Proposal and all other required elements along with the Cost Proposal.

b. Submit to the following email addresses and reference the RFP number in the subject line.

Procurement@dir.ca.gov CC: magbayani@dir.ca.gov https://caleprocure.ca.gov/pages/index.aspx mailto:Procurement@dir.ca.gov

3. Each proposal will be reviewed to determine if it meets the proposal requirements contained in Section lV, Proposal Requirements (Technical). Failure to meet the requirements for the RFP may be cause for rejection of the proposal.

4. A proposal may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all proposals and may waive any immaterial deviation in a proposal. The State’s waiver of immaterial defect shall in no way modify the RFP document or excuse the Proposer from full compliance with all requirements if the Proposer is awarded the Agreement.

5. DIR may modify the RFP up to the specified time of the date fixed listed for submission of proposals by the issuance of an addendum to all parties who received a proposal package. Any addendum(s) will be issued through the Cal eProcure system.

6. DIR reserves the right to reject any or all bids. The agency is not required to award an agreement. All bids may be rejected whenever the agency determines that the cost is not reasonable, the cost exceeds the amount estimated, or otherwise in the best interest of the State.

7. More than one (1) proposal from an individual, firm, partnership, corporation or association under the same or different names, will not be considered. Reasonable grounds for believing that any Proposer has submitted more than one proposal for the work contemplated herein will cause the rejection of all proposals submitted by that Proposer. If there is reason to believe that collusion exists among the Proposers, none of the participants in such collusion will be considered in this or future procurements.

E. Modification and/or Withdrawal of Proposals

1. A Proposer may modify a proposal after its submission by withdrawing its original proposal and resubmitting a new proposal prior to the proposal submission deadline.

Proposer modifications offered in any other manner, oral or written, will not be considered.

2. A Proposer may withdraw its proposal by submitting a written withdrawal request to DIR signed by the Proposer or an agent authorized in accordance with Section II.G., titled “Signature.” A Proposer may thereafter submit a new proposal prior to the proposal submission deadline. Proposals may not be withdrawn without cause subsequent to proposal submission deadline.

F. Proposer Responsibilities

1. Proposers should carefully examine the entire RFP, with special attention to the tasks and deliverables found in Attachment 2, Draft Standard Agreement.

Proposers shall investigate obstacles that might be encountered. No additions or increases to the agreement amount will be made due to a lack of careful examination of the requirements.

2. Before submitting a response to this RFP, Proposer(s) should review their response, correct all errors, and confirm compliance with the RFP requirements. It is the Proposer’s responsibility to complete and submit all required attachments as listed on Attachment 1.

3. Costs incurred for developing proposals and in anticipation of award of the Agreement are entirely the responsibility of the Proposer and shall not be charged to

DIR.

4. It is the Proposer’s responsibility to promptly notify DIR’s contract analyst identified in the solicitation, in writing, by e-mail, if the Proposer believes that the solicitation is unfairly restrictive, contains errors or discrepancies, or is otherwise unclear. Notification must be done immediately upon receipt of the solicitation in order that the matter may be fully considered and appropriate action taken by DIR prior to the closing time set to receive solicitation responses. Such notification must be submitted no later than the question and answer period referenced in Section II.A., Key Action Dates. All such correspondence received after the question and answer deadline will not be considered.

5. Proposer is responsible to review, read, understand, and comply in full with the

State’s General Terms and Conditions along with the Contractor’s Certification Clauses (CCC) as listed at: https://www.dgs.ca.gov/OLS/Resources/Page- Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract- Language.

6. Each proposal must constitute an irrevocable offer for a period of at least 180 working days after proposal submission.

7. The Proposer must provide evidence to show that members of the team possess the specific qualifications, competence, experience, resources, and business integrity necessary to carry out the work under the contract as expected. Examples of evidence include, but are not limited to: résumés, letters of reference, project summaries that highlight the team’s specific experience. Proposers must complete Attachment 3, Proposer References Form.

8. The Proposer must own and operate a legitimate business. If required by law, the

Proposer must be registered and in good standing within the California Secretary of State. All businesses that are required to be registered with the California Secretary of State must be registered prior to date of Agreement award. Evidence of registration shall be submitted with the proposal.

9. In the event that any license(s) and/or permit(s) expire at any time during the term of this agreement, Proposer agrees to provide agency a copy of the renewed license(s) and/or permit(s) within thirty (30) days following the expiration date. In the event the Proposer fails to keep in effect at all times all required license(s) and permit(s), the State may, in addition to any other remedies it may have, terminate this Agreement upon occurrence of such event.

https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language

10. It is unlawful for any person engaged in business within this state to sell or use any article or product as a “loss leader” as defined in Section 17030 of the Business and Professions Code.

11. The Proposer must complete and submit to DIR, the Payee Data Record (STD 204), Attachment 4, to determine if the selected proposer is subject to state income tax withholding, pursuant to California Revenue and Taxation Code, Section 18662.

This form can be found on the Internet at http://www.documents.dgs.ca.gov/dgs/fm c/pdf/std204.pdf . No payment shall be made unless a completed STD 204 has been returned to DIR. Payee Data Record Supplemental (Std. 205) (if applicable) https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std205.pdf

12. The Proposer must sign and submit to DIR, page one (1) of the Contractor

Certification Clauses (CCC 04/2017), Attachment 5, or the form can be obtained via the Internet at: https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of- Legal-Services-Resources-List-Folder/Standard-Contract-Language.

13. The Proposer must sign and submit to DIR, the California Civil Rights Laws

Certification, Attachment 6.

14. The Proposer must sign and submit to DIR, the Darfur Contracting Act Certification, Attachment 7.

15. The Proposer must complete and sign the GenAI Disclosure &

Factsheet Form, Attachment 12.

The State of California seeks to realize the potential benefits of GenAI, through the development and deployment of GenAI tools, while balancing the risks of these new technologies.

Bidder / Offeror / Contractor must notify the State in writing if their solution or service includes, or makes available, any GenAI, including GenAI from third parties or subcontractors.

The State has developed a GenAI Reporting and Factsheet (STD 1000) to be completed by the Bidder / Offeror / Contractor .

Failure to submit the GenAI Reporting and Factsheet (STD 1000) will result in disqualification of the Bidder / Offeror / Contractor.

Failure to report GenAI to the State may void any resulting contract. The State reserves its right to seek any and all relief it may be entitled to as a result of such non-disclosure.

Upon receipt of a Bidder / Offeror / Contractor GenAI Reporting and Factsheet (STD 1000), the state reserves the right to incorporate GenAI Special Provisions into the final procurement or reject quotes that present an unacceptable level of risk to the state.

http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std204.pdf https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std205.pdf https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.documents.dgs.ca.gov/dgs/fmc/pdf/std1000.pdf

G. Signature

1. All documents requiring signatures contained in the original proposal package must have original or electronic signatures.

2. Only an individual who is authorized to bind the proposing firm contractually shall sign the required Cover Letter for the proposal. The signature must indicate the title or position that the individual holds in the firm. An unsigned proposal may be rejected.

H. Disposition of Proposals

Upon proposal opening, all documents submitted in response to this RFP will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by the public. The State cannot prevent the disclosure of public documents.

I. Socio-Economic and Preference Programs

1. Disabled Veteran Business Enterprise (DVBE) Incentive – Optional

This solicitation does not require a minimum amount of DVBE participation.

However, you are strongly encouraged to either become certified, if eligible, or to subcontract a portion of the work to a certified DVBE. If a prime bidder is a certified DVBE or commits to subcontracting with DVBE(s), the bid may be eligible to receive a bid preference provided that the DVBE provides a commercially useful function as defined in California Military Code Section 999(i) and California Code of Regulations, Title 2, Section 1896.71. For evaluation purposes only, the State shall apply an incentive to bids that propose California certified DVBE participation as identified on Attachment 8, titled Bidder Declaration GSPD-05-105 and confirmed by the State. Proposers claiming the DVBE incentive must complete and return the Disabled Veteran Business Declarations form found at:

http://www.documents.dgs.ca.gov/pd/poliproc/STD-843FillPrintFields.pdf.

The incentive amount varies in conjunction with the percentage of DVBE participation offered. The minimum requirement is 1% with a maximum of 5% DVBE participation and the incentive will be equal to the participation offered as defined below:

Confirmed DVBE Participation of:

DVBE

Incentive:

1% to 1.99% inclusive 1% 2% to 2.99% inclusive 2% 3% to 3.99% inclusive 3% 4% to 4.99% inclusive 4%

5% or Over 5% http://www.documents.dgs.ca.gov/pd/poliproc/STD-843FillPrintFields.pdf

2. Small Business (SB) or Microbusiness (MB) Preference – Optional

If Proposer is claiming the 5% certified SB or MB preference, or is committing to subcontract 25% or more of their net bid price to one or more certified SB or MB (Non-small business preference [NSB]), list firm names on Attachment 8 (GSPD-05- 105 Bidder Declaration) and attach a copy of the certification. Additional References:

http://www.pd.dgs.ca.gov

Questions regarding the certification approval process or the SB program should be directed to the Department of General Services, Procurement Division at (800) 559- 5529 or (916) 375-4940; email: OSDSHelp@dgs.ca.gov. For the 24-Hour Recording & Mail Request call (916) 322-5060.

SB, MB or NSB bidders or proposers using the SB preference shall be granted a preference consisting of 5% of the highest responsible bidder’s total score.

3. Target Area Contract Preference Act (TACPA)

The TACPA preference will be granted for this solicitation. Proposers wishing to take advantage of this preference will need to review the following website and submit the appropriate response with their proposal: https://www.dgs.ca.gov/PD/Services/Page- Content/Procurement-Division-Services-List-Folder/Request-a-Target-Area-Contract- Preference?search=TACPA Proposers seeking to obtain a TACPA preference must complete and submit the TACPA Preference Request, STD. 830, and DGS/PD 526 with their Proposal. The STD. 830 and DGS/PD 526 are available to download at the link provided above.

4. Preference and Incentive Application – Optional

a. DVBE Incentive Points are factored by multiplying a Proposer’s DVBE participation commitment percentage (%) by the total possible points that could be awarded (see Table 1 below). This amount is then added to the proposer’s total points. In the Table 2 sample below, Proposer B received a 60-point incentive (.05% commitment x 1200 total points available), which was added to its total points resulting in its proposal ranking as first in line for award. Proposer C’s 2% commitment resulted in its receiving 24 incentive points, and making its proposal rank as second in line for award.

b. Preference is calculated by multiplying 5% of the highest scoring NSB proposer, and adding those points to SB proposers and NSBs subcontracting 25% or more to a SB. In the Table 2 sample below, the calculation is based on Proposer B’s 1155 points x .05 resulting in 57.75 additional points added to the certified SBs (A and C).

c. Under the High Score Method, it is possible to displace a high point certified SB with the application of the DVBE Incentive.

http://www.pd.dgs.ca.gov/ https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Request-a-Target-Area-Contract-Preference?search=TACPA https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Request-a-Target-Area-Contract-Preference?search=TACPA https://www.dgs.ca.gov/PD/Services/Page-Content/Procurement-Division-Services-List-Folder/Request-a-Target-Area-Contract-Preference?search=TACPA

TABLE 1: HIGH SCORE METHOD SAMPLE

Available points example using sliding scale:

Administrative: 200 points Technical: 400 points

Cost: 600 points Total: 1200 points

Possible Maximum 60 points DVBE incentive calculated as follows:

Confirmed DVBE Participation Possible Points Calculation:

1% - 1.99% inclusive 1% X 1200 = 12 2% - 2.99% inclusive 2% X 1200 = 24 3% - 3.99% inclusive 3% X 1200 = 36 4% - 4.99% inclusive 4% X 1200 = 48

5% and Higher 5% X 1200 = 60

TABLE 2: HIGH SCORE METHOD SAMPLE RESULTS

Proposer A B C Responsive/Responsible Yes Yes Yes

Total Points 1050 1155 1125 Eligible Preference SB None SB

SB Preference Points Applied

57.75 0 57.75

Subtotal 1107.75 1155 1182.75 Rank 3 2 1

Confirmed DVBE Participation

No (0%) Yes (5%) Yes (2%)

Incentive Points Applied None 60 24 Adjusted Points 1107.75 1215 1206.75

New Rank 3 1 2

III. PROPOSAL REQUIREMENTS (TECHNICAL)

A. Proposal Requirements

The proposal must contain the following components, information and documents outlined below. Each requirement’s location must be listed in the Proposal’s Table of Contents. Also see Section II. D. Submission of Proposal, for general submittal details.

1. Minimum Qualifications

The Proposer must provide a detailed response, outlining information as to how the Proposer meets each of the minimum qualifications listed below. The Proposer must provide their detailed response on Attachment 11, Detailed Response for Minimum Qualifications. Proposals that do not meet the minimum qualifications will be determined non-responsive and ineligible for award.

a. Proposer shall have a minimum of five (5) years of experience working with workers’ compensation fee schedules.

b. Proposer shall have a minimum of three (3) years of demonstrated ability in handling high-volume case workload in a bill review setting.

c. Proposer shall have a minimum of three (3) years of demonstrated ability to provide data regarding bill review status and outcomes.

d. Proposer shall have experience with creating a case workflow tracking system for cases being submitted for independent bill review.

e. Proposer shall have an office in California and shall have a minimum of three

(3) years experience maintaining and recruiting qualified reviewers who are administratively and professionally capable of providing timely, complete and professional case analyses and determinations as described in Labor Code section 4603.6 and 8 C.C.R. section 9792.5.9, et seq.

f. Proposer shall employ a medical director who shall be a physician and surgeon licensed by the Medical Board of California or the California Osteopathic Medical Board and who shall be responsible for advising Contractor on clinical issues.

2. Title Page

The purpose of this page is to provide information needed by DIR administrative staff. It must contain the following items:

a. The title of the proposal, which must be the same as the title of the RFP;

b. The number of the RFP, S23DWC036; and

c. The date of proposal.

3. Cover Letter / Letter of Commitment

The cover letter must not be more than two (2) pages, in Arial size-12 point font or similar, and must include the following paragraph and the signature of the representative authorized to make the proposal on behalf of the firm:

“The enclosed proposal is submitted in response to the above referenced Request for Proposal S23DWC036, including any addenda. Through submission of this proposal, we agree to all of the terms and conditions of the Request for Proposal, and agree that any inconsistent provisions in our proposal may result in a lower score, up to and including disqualification. We have carefully read and examined the Request for Proposal, and have conducted such other investigations as were prudent and reasonable in preparing the proposal. We agree to be bound by statements and representations in our proposal.”

The cover letter must be provided on the company’s letterhead and include the following information and statements:

a. The name and address of your company [NOTE: You may use a Post Office box, but please provide your company's street address]; and

b. The name, title, and signature of a company official authorized to bind the proposal.

c. Name, email and/or phone number for the Proposer’s contact for DIR inquiries related to the proposal.

4. Table of Contents

5. Summary

The abstract shall be not longer than one (1) page. Include a brief description of the proposed project briefly summarizing the main point of the various sections of the proposal, including the features and benefits of the proposal.

6. Minimum Qualifications Response

Provide a response, outlining detailed information demonstrating how the Proposer meets each of the minimum qualifications listed in Section III.A. Submit all applicable documentation.

7. Required Attachments

The Technical Proposal must include all of the completed attachments listed in Attachment 1, Required Attachment checklist.

8. References

Each proposer must provide at least 3 references detailing previous experience Determining bill reviews in the California Workers’ Compensation System. related to the goals and objectives outlined in the RFP.

References must be provided using Attachment 3, Proposer References Form.

Submission of this attachment is mandatory. Failure to fully complete and return this attachment with your proposal may cause your proposal to be rejected and deemed non-responsive. Attachment 3 may be copied for additional references.

9. Conflict of Interest and Confidentiality Statement

Proposer and each member of Proposer’s technical staff proposed to work on this project must sign and submit Attachment 2, Draft Standard Agreement, Exhibit G – Acknowledgment of Confidentiality with your proposal.

10. Subcontracts/Subcontractors

If subcontractors are to be used, the Proposer must include in the Technical Proposal, a description of each person or firm and the work to be done by each subcontractor. Please use Attachment 8, Bidder Declaration Form (GSPD 05-105), to list all subcontractors used for this project. All subcontracts must be approved by DIR, and no work shall be subcontracted without the prior written approval of the State. The cost of the subcontract work is to be itemized in the Cost Proposal as described below in the section entitled Cost Proposal Requirements, and not in the Technical Proposal.

11. Technical Portion

Proposer shall demonstrate their understanding of the questions, or needs, that DIR is seeking to have addressed. The technical approach and work plan are considered the heart of the proposal and will receive a high level of scrutiny. This part of the proposal will be evaluated to ensure all tasks and deliverables, listed in the Scope of Work, are included and responsive. The technical portion of the Proposal must include a written response to all scoring elements listed in the sample Proposal Evaluation form, Section IV.B.3, and must include the following:

a. Management Plan

The Proposer shall provide a project management plan including the management structure and project organization. The Proposer shall designate, by name, the Project Manager to be employed. The selected Proposer shall not cause the substitution of the Project Manager without prior written approval of the State. Proposers should include methods to measure project progress against the project management plan to maintain project schedule.

b. Methodology (Approach to Work)

The Proposer shall describe their methodology and approach to the work, identify specific techniques and methodologies that will be used and specific administrative and operational management expertise that will be employed in order to accomplish the tasks listed in this RFP under Attachment 2, Draft Standard Agreement. Proposer shall indicate how skills developed in previous related work will be applied to the work described in this RFP.

The Proposer shall demonstrate their knowledge in determining bill reviews in the California Workers’ Compensation System, the subject of the RFP and lay the groundwork for the actual work to be performed for this project.

c. Work Plan and Work Schedule

The Proposer shall develop a Work Plan and Work Schedule that allows all tasks to be completed within the timeframes outlined in the Scope of Work. The Work Plan and Work Schedule shall identify each major task, necessary subtasks, and milestones by which progress can be measured and payments made. The Work Plan shall specify the estimated hours to accomplish each task and the Work Schedule shall provide the responsible party for performing the task, and anticipated dates of completion.

The Work Plan and Work Schedule must reflect the total project timeline of 36 months.

The Work Plan shall indicate how the supervision and oversight will be conducted for ensuring that the project will remain on schedule and that the distribution of workload is appropriate.

See Attachment 2, Draft Standard Agreement, for details on the tasks required.

A work plan schedule format is provided below:

TASK RESPONSIBLE

PARTY

(Prime or Subcontractor)

DATE OF COMPLETION

TASK 1: Migration of existing IBR Data

10 days after contract executed

TASK 2: Develop procedures and workflow manuals to process IBR cases.

Within 30 days after contract execution

TASK 3: Develop web based online management system to process and track all IBR caseload.

Within 60 days after contract execution

TASK 4: Present to DWC for feedback on above tasks

Within 70 days after contract execution

TASK 5: User testing and training

Within 80 days after contract execution

TASK 6: Case management system fully operational to make determinations on all eligible IBR cases.

On or before 12/31/2024

TASK 7: Execution of the IBR procedures as specified

January 1, 2025

d. Personnel / Experience / Work Samples

For this criterion, reviewers will rate the Proposer’s experience in conducting similar or related work described in the Scope of Work, and how skills developed in previous related work will be applied to this project as outlined in Attachment 2, Draft Standard Agreement. The Proposer shall indicate how previous experience will be applied to the development of this project.

The Proposer shall list technical staff (specify staff name) who will be working on the project. Include their titles, qualifications, a summary of similar work or studies performed, a resume for each technical staff person, a statement indicating how many hours each professional will be assigned to the Agreement and what tasks each professional will perform. The selected Proposer shall not cause key members of the project team to be substituted without prior written approval of the State.

The Proposer shall demonstrate experience and breadth of knowledge in determining bill reviews in the California Workers’ Compensation System as described in Attachment 2, Draft Standard Agreement.

The Proposer shall provide work samples of previous completed work that required the use of similar methodology or approaches. A minimum of two (2) work samples and no more than four (4) must be provided that demonstrates they have the required experience and illustrates the proposer’s operational effectiveness, execution capabilities, and/or creative strengths. The work samples will be evaluated for the understanding of related laws, regulations, and empirical findings used in prior work

Proposer shall ensure that at all times it will have sufficient numbers of reviewers available to satisfy the review time frames set forth in this RFP. (i.e., the number and types of cases eligible for IBR is likely to increase when fee schedules for interpretation services, copy services, and home care services are established or amended by the Administrative Director. Proposals will be evaluated for readability, organization, specificity, and ability to communicate concepts clearly and succinctly. Proposals will be viewed as samples of the type of final work products that the DIR could expect to receive from a respondent, if selected.

e. Interview/Presentation

The proposer and their project management team must appear in person or via videoconference call for an in-person interview by DIR’s evaluation committee. If the bidder chooses to appear in person, travel costs incurred by the bidder are the responsibility of the bidder and will not be reimbursed by the State.

During this evaluation phase, the DIR will evaluate each bid based upon a presentation of the written proposal.

The evaluation team shall make all efforts to standardize the interview process and ask the same questions to all bidders. Interview questions are based upon the minimum requirements of the RFP and ability to respond to the DIR’s needs. All interviews shall be evaluated by the criteria stated in C. Proposal Evaluation Form and ranked based upon quality of response.

This interview shall be conducted either via video conference or in person at the DIR office located at:

Department of Industrial Relations 1515 Clay Street Oakland, CA 94612

This presentation is an integral part of the RFP process. Failure to make this oral presentation will be considered nonresponsive to this RFP and the proposal will be rejected

f. Page Headers and Page Numbering

All pages of the Technical Proposal, including cover pages, Table of Contents, references and resumes, and the Bidder Declaration Form GSPD-05-105 (Attachment 8) shall have the following header and page numbering format in the upper right-hand corner:

Technical Proposal

Exhibit A, Attachment 1 Page ## of ##

B. Cost Proposal Requirements

The cost breakdown (Cost Proposal) shall be included in the Technical Proposal. Cost Proposals shall include the following required information: Budget, and Preference Program Documents (See Section lI. Socio-Economic and Preference Programs) and at a minimum, all information listed in Cost Detail (below). Proposers must use the Attachment 10, Contractor Cost Sheet.

All costs must be provided for each task and deliverable. The proposed costs should be broken down into the outline in the Work Plan and Work Schedule for the purpose of this cost proposal submittal.

DIR’s budget for the proposed contract is limited to $0.00. The services performed under this contract will be billed independently and directly by the selected IBRO to the claims administrator or provider. The IBRO may bill up to $335 per review performed under this contract. Proposals exceeding $335 per review may be deemed non-responsive and ineligible for award. Proposers shall submit a cost proposal for all tasks described in Attachment 2, Draft Standard Agreement.

1. Cost Detail

a. Itemized Tasks – Using Attachment 10, Contractor Cost Sheet, provide firm-fixed costs for specific tasks listed in Attachment 2, Draft Standard Agreement.

For all tasks, the Proposer must include all items such as labor, personnel, subcontractors, travel, meetings, materials, reports, and tax, if applicable, as necessary to perform and complete the tasks on the Contractor Cost Sheet, Attachments 10.

b. Subcontracts / Subcontractors – If subcontractors are to be used, the Proposer must include in the Technical Proposal, a description of each person or firm and the work to be done by each subcontractor. Additionally, all subcontractors proposed to be used for this project must be identified on Attachment 8, Bidder Declaration Form.

2. Page Headers and Page Numbering

All pages of the Cost Proposal; the Bidder Declaration Form GSPD-05-105 (Attachment 8); and, if applicable, any forms pertaining to socio-economic preferences (SB, MB, or DVBE), shall have the following header and page numbering format in the upper right-hand corner:

Cost Proposal

Exhibit B, Attachment 1 Page # of ##

IV. EVALUATION, SELECTION, AND AWARD

A. Administrative Evaluation (Phase 1)

DIR will conduct an administrative evaluation in accordance with the RFP requirements to determine a Proposer’s responsiveness and responsibility. Each proposal will be checked for completeness and/or absence of all required information and to ensure that the Proposer meets the minimum qualifications in conformance with the submission requirements. During the evaluation period, if an item is unclear, or needs further clarification, Proposers may be requested to provide additional documentation.

B. Technical Evaluation (Phase 2)

DIR will also conduct an evaluation of the Technical Proposal & Interview by an evaluation panel consisting of DIR employees. If deemed necessary, independent academic, technical or policy experts may be called upon to answer any specific questions regarding the responses to the RFP. These individuals will not participate in the scoring process.

1. Scoring Criterion Guidelines

Note: There will be no individual sheets, no written scores, and no written notes. There will be one final score for each Proposer. Proposer must score a minimum of 70 points (combined score of technical evaluation and cost points) to be eligible for award.

The Proposal Evaluation Form in Section IV.B.3 contains the scoring criteria that will be used by reviewers evaluating proposals submitted in response to this RFP. The evaluation team shall determine a consensus score for each item, based on the team's verbal discussion of each Proposer's responses. To determine the consensus score, evaluators will meet either in person or by teleconference to discuss in detail the strengths, weaknesses, and ratings of each proposal to determine scores. The evaluation team will carefully review and discuss the completeness of the Proposer's response, as well as clarity of documentation presented in the proposals submitted in response to this RFP.

2. Cost Points (30 points)

Proposers may achieve a maximum of thirty (30) cost points. This criterion allows staff to evaluate and compare the budgets of each proposal relative to those of its competitors. The budgeted amount is the maximum allowable amount by DIR for this Agreement (Section III.B.). Any proposals submitted that are over the expected expenditure/budgeted amount may be disqualified.

The technically qualified proposal that has the lowest cost will be given a maximum score of thirty (30) for this criterion.

All other technically qualified proposals will be calculated based on the ratio of the lowest cost proposal to the bidder’s cost, multiplied by the maximum number of cost points available thirty (30), as shown in the example below:

Lowest Total Cost Bid X Total Cost Points Available

Bidder Total Cost

Example: To help illustrate this process, refer to the Cost Evaluation Methodology Example table below for the cost score calculation process. Cost figures in this example explain the cost calculations and have no other significance.

Cost Evaluation Methodology Example

Bidder Grand Total Cost Calculation Cost Points

Awarded

A $350,000 $300,000 X 30 $350,000 26

B $325,000 $300,000 X 30 $325,000 28

C $300,000 $300,000 X 30 $300,000 30

Final Scoring Methodology Example

Bidder Technical Score Cost Score Total Points Awarded

A 81 26 107 B 86 28 114 C 92 30 122

In this case, the highest scored proposal from Bidder C would be the intended awardee.

Preferences will be applied as required to eligible proposals. Please see Section II.I., Socio-Economic and Preference Programs.

The evaluation team will abide by the following Scoring Criterion Guidelines for the Technical Evaluation Scoring Criteria below:

Possible Points Interpretation Explanation for Percentage Points

0% Inadequate Response does not include or fails to address the requirements being scored. The omission(s), flaw(s), or defect(s) are significant and unacceptable.

30% Barely Adequate

Response addresses the requirements being scored, but there are one or more omissions, flaws, or defects or the requirements are addressed in such a limited way that it results in a low degree of confidence in the proposed solution.

80% Good

Response fully addresses the requirements being scored with a good degree of confidence in the Applicant’s response or proposed solution. No identified omission(s), flaw(s), or defect(s). Any identified weaknesses are minimal, inconsequential, and acceptable.

100% Excellent or Outstanding

Response fully addresses the requirements being scored with a high degree of confidence in the Applicant’s response or proposed solution. Applicant offers one or more enhancing features, methods or approaches exceeding basic expectations.

The Proposal Evaluation criteria listed specifies the total number of points available for each requirement. Using the Scoring Criterion Guidelines, the evaluation team will determine the percentage of points to be awarded to each requirement, and multiply that percentage by the total number of points available for that requirement to determine the score.

3. Interview Criteria and Scoring

The Proposer’s team members will be rated between 0-3 points, based on the interview responses. The Proposer’s team members must be available for an interview as described in SECTION A, KEY ACTION DATES, of this document. All interview questions will be directed to the Proposer’s team members only; the Proposer is not part of the interview process unless the Proposer and the proposed team members are one in the same person. Proposer’s will be scored on the following:

1. Project Presentation: Thorough and clear presentation that provides an overview of the more complex aspects of the project that is accessible to a non-technical audience. Demonstration of the ability to develop an online case flow tracking system for cases being submitted for independent medical review.

2. Respondents will be required to explain and respond to questions regarding their experience and expertise. Points will be awarded based upon the quality, pertinence and degree of experience demonstrated by the Respondent.

4. Proposal Evaluation Form

MINIMUM QUALIFICATIONS Yes No

Proposer shall have a minimum of five (5) years of experience working with workers’ compensation fee schedules.

Proposer shall have a minimum of three (3) years of demonstrated ability in handling high-volume case workload in a bill review setting.

Proposer shall have a minimum of three (3) years of demonstrated ability to provide data regarding bill review status and outcomes.

Proposer shall have experience with creating a case workflow tracking system for cases being submitted for independent bill review.

Proposer shall have an office in California and shall have a minimum of three (3) years experience maintaining and recruiting qualified reviewers who are administratively and professionally capable of providing timely, complete and professional case analyses and determinations as described in Labor Code section 4603.6 and 8 C.C.R.

section 9792.5.9, et seq.

Proposer shall employ a medical director who shall be a physician and surgeon licensed by the Medical Board of California or the California Osteopathic Medical Board and who shall be responsible for advising Contractor on clinical issues.

If any minimum qualifications are NOT met, STOP HERE

1. CLARITY AND ORGANIZATION OF PROPOSAL Points Available

Points Awarded

The proposal is presented in a clear, organized manner. 5

2. MANAGEMENT PLAN Points Available

Points Awarded

Proposer shall provide a clear project management plan including the management structure and project organization. Proposer shall designate, by name, the Project Manager to be employed.

The Proposer should include methods to measure project progress against the project management plan to maintain project schedule.

3. METHODOLOGY (APPROACH TO WORK) Points Available

Points Awarded

Proposer shall describe their methodology and approach to the work, identify specific…