RFP_S24DWC005_Final.pdf

STATE OF CALIFORNIA GAVIN NEWSOM, Governor

REQUEST FOR PROPOSAL (SECONDARY METHOD)

Notice to Prospective Proposers RFP No. S24DWC005

July 22, 2024

You are invited to review and respond to this Request for Proposal (RFP) No. S24DWC005, titled, “Independent Medical 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 8, 2024, no later than 1:00 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 XXXXXX [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: wluong@dir.ca.gov CC: abarron@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: Winson Luong Email: wluong@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.

Department of Industrial Relations RFP No. S24DWC005

Table of Contents

SECTION PAGE

I. PURPOSE / BACKGROUND / SCOPE OF WORK 3

A) Purpose 3 B) Background 4 C) Scope of Work 4

II. PROPOSAL REQUIREMENTS (GENERAL) AND INFORMATION 5

A) Key Action Dates 5 B) Questions Regarding RFP Requirements 6 C) General Proposal Requirements 6 D) Submission of Proposals 6 E) Modification and/or Withdrawal of Proposals 7 F) Proposer Responsibilities 8 G) Signature 10 H) Disposition of Proposals 10 I) Socio-Economic and Preference Programs 10

III. PROPOSAL REQUIREMENTS (TECHNICAL) 12

A) Technical Proposal Requirements 12

1) Minimum Qualifications 12

2) Title Page 13

3) Cover Letter / Letter of Commitment 13

4) Table of Contents 13

5) Summary 13

6) Minimum Qualifications Response 14

7) Required Attachments 14

8) References 14

9) Conflict of Interest and Confidentiality Statement 14

10) Subcontracts / Subcontractors 14

11) Technical Portion 14

a. Management Plan 15

b. Methodology (Approach to Work) 15

c. Work Plan and Work Schedule 15

d. Personnel / Experience 16

e. Interview / Presentation 17

f. Page Headers and Page Numbering 17

B) Cost Proposal Requirements 18

1) Cost Detail 18

2) Page Headers and Page Numbering 18

IV. EVALUATION, SELECTION, AND AWARD 19

A) Administrative Evaluation (Phase 1) 19

1) Responsive and Responsible Proposer 19 B) Technical Evaluation (Phase 2) 19

1) Scoring Criterion Guidelines 19

2) Cost Points 19

3) Interview Criteria and Scoring 21

4) Proposal Evaluation Form 22 C) Proposal Rejection 24 D) Selection 25

E) Notice of Proposed Award 25 F) Standard Conditions of Service 26 G) Post Award Requirements 26

ATTACHMENTS

1. Required Attachment Checklist 27

2. Draft Standard Agreement (STD 213) 28

Exhibit A, Scope of Work 29 Exhibit A, Attachment 1 – Technical Proposal 57 Exhibit B, Budget Detail and Payment Provisions 58 Exhibit B, Attachment 1 – Contractor Cost Sheet 59 Exhibit C, General Terms and Conditions (GTC 04/2017) 60 Exhibit D, Special Terms and Conditions 61 Exhibit E, Additional Provisions 68

Exhibit F, Statement Regarding Confidentiality and Security of DIR Information

Exhibit G, Acknowledgment of Confidentiality 73

3. Proposer References Form 74

4. Payee Data Record (STD 204) 75

5. Contractor Certification Clauses (CCC 04/2017) 77

6. California Civil Rights Laws Certification 81

7. Darfur Contracting Act Certification 82

8. Bidder Declaration Form 83

9. CA DVBE Bid Incentive Instructions 85

10. Contractor Cost Sheet 88

11. Detailed Response for Minimum Qualifications 89

12. GenAI Disclosure & Factsheet Form 90

I. PURPOSE / BACKGROUND / SCOPE OF WORK

A. Purpose

This Request for Proposal (RFP) is to solicit competitive proposals from experienced and qualified contractors to conduct independent medical reviews submitted to DIR under Labor Code section 4610.51 and California Code of Regulations, Title 8 (8 C.C.R.), section 9792.10.12, et seq.

For a detailed description of the work to be performed, please refer to Attachment 2, Draft Standard Agreement. The work of this contract is expected to require thirty-six

(36) months; 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 shall be billed independently and directly by the Contractor to the claims administrators. The Contractor may bill up to $495 per review performed under this

1 https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=4610.5.&lawCode=LAB 2 https://www.dir.ca.gov/t8/9792_10_1.html contract. Proposals exceeding $495 per review may be deemed non-responsive and ineligible for award.

B. Background

The purpose of this contract is for the Department of Industrial Relations (DIR) Division of Workers’ Compensation (DWC) to contract with an independent medical review (IMR) organization to conduct independent medical reviews submitted to DWC under Labor Code section 4610.53 and California Code of Regulations, title 8 (8 C.C.R.), section 9792.10.14, et seq.

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 affects how medical necessity determinations are made for medical care provided to injured workers. Effective January 1, 2013, for injuries occurring on or after that date, and effective July 1, 2013, for all dates of injury, IMR must be used to decide disputes between physicians and claims administrators about necessary medical treatment for injured workers.

A request for medical treatment in the workers' compensation system must go through a "utilization review" process to confirm that it is medically necessary before it is approved. If utilization review (UR) denies or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, the injured employee or their representative can ask for a review of that decision through IMR. In the IMR process, independent medical professionals, instead of workers’ compensation judges, make medical necessity determinations.

Because of the importance of IMR in the delivery of appropriate treatment for injured workers, freedom from conflicts of interest is a fundamental requirement. Minimum requirements are specified by statute for both the independent medical review organization (IMRO) and the individual reviewers.

The IMR program is administered by DIR with costs borne by the employer. DIR is required to contract with one or more independent medical review organizations (IMROs) to conduct IMR on its behalf.

C. Scope of Work

The proposer shall conduct independent medical review for cases that are required to go through the DIR Independent Medical Review process. Contractor shall maintain a case workflow tracking system to track the receipt, acceptance, assignment, and current status of applications and cases accepted for IMR as specified in Attachment 2, Draft Standard Agreement, Exhibit A: Scope of Work.

3 https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=4610.5.&lawCode=LAB 4 https://www.dir.ca.gov/t8/9792_10_1.html

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.

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 Actions Dates Time RFP available to prospective Proposers 07/22/24 N/A Written Questions Submittal Deadline 07/30/24 5:00 p.m.

Question and Answers Addendum Posted 08/05/24 5:00 p.m.

Final Date for Proposal Submission/Receipt by DIR

08/08/24 1:00 p.m.

Complete Evaluation of Proposals 08/12/24- 08/14/24

N/A

Interviews 08/19/24 3:00 p.m.

Posting of Intent to Award Notice(s) (Notice is posted for five [5] business days) 08/21/24 N/A

Agreement sent to successful Proposer 08/26/24 N/A Signed Agreement returned to DIR for counter-signature

08/30/24 N/A

Agreement Approved and Executed – work begins

10/1/24 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:

Office of Administrative Services Contracts, Procurement, and Business Services Branch Contact: Winson Luong Email: wluong@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: wluong@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.

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 contract or reject bids/offers that present an unacceptable level of risk to the state.

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

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%

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.

4. Preference and Incentive Application – Optional

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.

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).

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

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 and familiarity with evidence-based medical treatment and guidelines and understanding of the workers’ compensation Medical Treatment Utilization Schedule (MTUS) in the State of California.

b. Proposers shall have a minimum of five (5) years of experience managing at least 100,000 electronic submissions of reviews in a medical treatment review setting as described in this RFP.

c. Proposers shall have a minimum of five (5) years of experience conducting medical reviews.

d. Proposer shall have a minimum of five (5) years of experience showing the ability to provide data regarding medical review case status and outcomes

e. Proposer must have experience with creating a case flow tracking system for cases being submitted for independent medical review that is accessible to DIR users.

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, S24DWC005; 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 S24DWC005, 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 three (3) references detailing previous experience doing medical reviews 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 Attachment 1 – Acknowledgement of Confidentiality Statement 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.D, 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 conducting medical reviews, 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. 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 sample work plan schedule is provided below:

TASK RESPONSIBLE

PARTY

(Prime or Subcontractor)

Hours to complete

DATE OF

COMPLETION

Task 1: Migration of Existing IMR Data

10 days after contract execution

Task 2: Develop procedures and

Within 30 days after contract execution

TASK RESPONSIBLE

PARTY

(Prime or Subcontractor)

Hours to complete

DATE OF

COMPLETION

workflow manuals to process IMR cases Task 3: Develop web-based online case workflow tracking system to process and track all IMR caseload

Within 60 days after contract execution

Task 4: Present Task 1 and 2 to DIR for feedback

Within 70 days after contract execution

Task 5: Testing and Training completed for users and product is ready to go live.

Provide final product for DIR review

Within 80 days after contract execution

Task 6: Case workflow tracking system fully operational to make determinations on all eligible IMR cases

On or before 12/31/2024

Task 7: Execution of the IMR Procedures as specified

01/01/2025

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 completing medical reviews as described in Attachment 2, Draft Standard Agreement.

The Proposer provides work samples of previously 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 demonstrate they have the required experience and illustrate the proposer’s operational effectiveness and experience on the following:

Experience with creating a case flow tracking system for cases being submitted for independent medical review.

Experience and familiarity with evidence-based medical treatment and guidelines and understanding of the workers’ compensation Medical Treatment Utilization Schedule (MTUS) in the State of California.

Demonstrated ability to handle high-volume case workload in a medical review setting.

Experience managing electronic submissions of reviews and handling a large volume of medical reviews.

Demonstrated ability to provide data regarding medical review status and outcomes.

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 Section IV (b)(3) Interview Criteria and Scoring 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:

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

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.

DIR’s budget for the proposed contract is $0.00. The services performed under this contract shall be billed independently and directly by the Contractor to the claims administrators. The Contractor may bill up to $495 per review performed under this contract. Any cost proposals exceeding this amount will be disqualified 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 processing claims as 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 services 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, and interview points) to be eligible for award.

The Proposal Evaluation Form in Section C 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

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

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

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.

Possible

Interpretation Explanation for Percentage Points

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.

Each criterion in the bidder proposal will be reviewed and ranked from highest to lowest based upon the rating scale below. A score shall be assessed independently by each evaluator; then the evaluators shall meet to discuss their scores. Any major deviations will be discussed in the group whereby each party provides their rationale for their scoring. The final score shall reflect both the independent assessment and the collaborative discussion.

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 C, 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 and familiarity with evidence-based medical treatment and guidelines and understanding of the workers’ compensation Medical Treatment Utilization Schedule (MTUS) in the State of California.

Proposers shall have a minimum of five (5) years of experience managing at least 100,000 electronic submissions of reviews in a medical treatment review setting as described in this RFP.

Proposers shall have a minimum of five (5) years of experience conducting medical reviews.

Proposer shall have a minimum of five (5) years of experience showing the ability to provide data regarding case status and outcomes.

Proposer must be able to develop a system that can be accessed by authorized DIR users to track status of reviews and retrieve other information.

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

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

Awarded

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 conducting medical reviews, the subject of the RFP and lay the groundwork for the actual work to be performed for this project.

4. WORK PLAN AND WORK SCHEDULE

Points Available

Points

Awarded Proposer shall develop a Work Plan and Work Schedule that allows all tasks to be completed withing 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.

5. PERSONNEL / EXPERIENCE / SAMPLES

Points

Awarded Proposer describes experience in conducting similar or related work described in the Scope of Work, and how skill developed in previous related work will be applied to this project as outlined in Attachment 2, Draft Standard Agreement. 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.

Proposer shall provide work samples of previously 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 demonstrate they have the required experience…