RFP_S24DWC008-Addendum_1.pdf

STATE OF CALIFORNIA GAVIN NEWSOM, Governor

Department of Industrial Relations Business Management Office – Contracts Unit 1515 Clay Street, Suite 301 Oakland, CA 94612

California Department of Industrial Relations Request for Proposal (RFP) Notice to Prospective Bidders

Addendum No. 1 August 21, 2024

DIR RFP # S24DWC008 – UEBTF Bill Review

Department of Industrial Relations (DIR) is issuing this Addendum No. 1 to make changes to page 1 of the RFP referenced above.

Please see the revisions as follows: All deletions are shown in strikethrough, and additions are shown in bold and an underline.

Any questions are to be addressed to the contact listed below:

Winson Luong wluong@dir.ca.gov

STATE OF CALIFORNIA Gavin Newsom Governor

REQUEST FOR PROPOSAL (PRIMARY METHOD)

Notice to Prospective Proposers RFP No. S24DWC008

August 20 21, 2024

You are invited to review and respond to this Request for Proposal (RFP) No. S24DWC008, titled, “UEBTF 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 29 September 13, 2024, no later than 1:00 pm. 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 S24DWC008 (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.

RFP No. S24DWC008

Table of Contents

SECTION PAGE

I. PURPOSE / BACKGROUND / SCOPE OF WORK 4

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

II. PROPOSAL REQUIREMENTS (GENERAL) AND

INFORMATION

A) Key Action Dates 5 B) Questions Regarding RFP Requirements 5 C) General Proposal Requirements 6 D) Submission of Proposals 7 E) Modification and/or Withdrawal of Proposals 8 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 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) Statement Regarding Confidentiality and Security of DIR Information and Acknowledgement of Confidentiality

10) Subcontracts / Subcontractors 14

11) Technical Portion 14

a. Management Plan 14

b. Methodology (Approach to Work) 14

c. Work Plan and Work Schedule 15

d. Personnel / Experience 15

e. Page Headers and Page Numbering 16

B) Cost Proposal Requirements 16

1) Cost Detail 17

2) Page Headers and Page Numbering 17

IV. EVALUATION, SELECTION, AND AWARD 17

A) Administrative Evaluation (Phase 1) 17 B) Technical Evaluation (Phase 2) 17

1) Scoring Criterion Guidelines 17

2) Proposal Evaluation Form 19

C) Cost Proposal Opening and Evaluation 20 D) Proposal Rejection 21 E) Selection 21 F) Notice of Proposed Award 22

G) Standard Conditions of Service 22 H) Post Award Requirements 23

ATTACHMENTS

1. Required Attachment Checklist 24

2. Draft Standard Agreement (STD 213) 25

Exhibit A, Scope of Work 26 Exhibit A, Attachment 1 – Explanation of Review Sample 36 Exhibit A, Attachment 2 – Payment Category and Stub

Note Codes

Exhibit A, Attachment 3 – Technical Proposal 38 Exhibit B, Budget Detail and Payment Provisions 39 Exhibit B, Attachment 1 – Contractor Cost Sheet 41 Exhibit C, General Terms and Conditions (GTC 04/2017) 42 Exhibit D, Special Terms and Conditions 43 Exhibit E, Additional Provisions 50

Exhibit F, Statement Regarding Confidentiality and Security of DIR Information

Exhibit G, Acknowledgment of Confidentiality 56

3. Proposer References Form 57

4. Payee Data Record (STD 204) 58

5. Contractor Certification Clauses (CCC 04/2017) 60

6. California Civil Rights Laws Certification 64

7. Darfur Contracting Act Certification 65

8. Bidder Declaration Form 66

9. CA DVBE Bid Incentive Instructions 68

10. Contractor Cost Sheet 71

11. Detailed Response for Minimum Qualifications 73

12. GenAI Reporting & Factsheet (STD 1000) 74

13. Annual Certification of Medical Bill Reviewers 75

I. PURPOSE / BACKGROUND

A. Purpose

This RFP is to solicit competitive proposals from experienced and qualified contractors to provide health care provider bill review services for the Uninsured Employers Benefits Trust Fund (UEBTF) and the Subsequent Injuries Benefits Trust Fund (SIBTF) within the DIR, Division of Workers Compensation (DWC).

DIR is seeking one full-service contractor to review bills from health care providers submitted to UEBTF and SIBTF for their treatment or services provided to injured workers who are entitled to workers’ compensation benefits. Health care providers include, but are not limited to physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services.

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 $750,000.00. Proposals exceeding this amount may be deemed non-responsive and ineligible for award.

B. Background

DIR’s UEBTF pays claims when illegally uninsured employers fail to pay workers’ compensation benefits awarded to their injured employees by DIR’s Workers’ Compensation Appeals Board (WCAB). DIR’s SIBTF is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. As such, the Fund receives medical bills from health care providers and is tasked to responsibly and efficiently evaluate these bills presented on behalf of injured workers.

To do this, the Fund contracts with a certified bill reviewing service, to ensure bills are sufficiently evaluated and paid in a timely fashion.

C. Scope of Work

The proposer shall review medical bills from health care providers submitted to DIR for their treatment of or for services provided to injured workers who are entitled to workers’ compensation benefits. Health care providers include, but are not limited to, physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services.

The proposer shall make available for use a health care provider bill review tracking system (BRTS) that provides bill reviews, explanation of reviews, medical reports. In addition, the BRTS shall include information such as submission of requests by each adjuster, pending transactions, and other information.

The proposer’s BRTS shall be capable of interfacing with the system that is providing Utilization Review services for DIR such that it can electronically capture physician’s Request for Authorizations (RFAs) that were approved, modified, or denied.

The proposer shall provide statistical reports to DIR regarding the status of all bills submitted for review.

The proposer shall conduct initial and periodic training for DIR staff to ensure that they are fully aware of their responsibilities in administering the bill review program. The proposer shall also provide training regarding the bill review tracking system.

For a detailed description of the work to be performed, please refer to 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 8/21/2024 N/A Written Questions Submittal Deadline 8/27/2024 1:00 p.m.

Question and Answers Addendum Posted 9/3/2024 2:00 p.m.

Final Date for Proposal Submission/Receipt by

DIR

9/13/2024 1:00 p.m.

Complete Evaluation of Proposals 9/16/2024- 9/18/2024

N/A

Public Opening of Cost Proposals which have been successful in Technical Review

Opening of Bids via Microsoft TEAMS:

Link: Click Here to Join Meeting

9/23/2024 3:00 PM

Meeting ID: 297 208 084 828 Passcode: yGctmu

Dial in by phone +1 619-407-9860 Phone conference ID: 388 838 369# Posting of Intent to Award Notice (Notice is posted five [5] business days)

9/24/2024 N/A

Agreement sent to successful Proposer 10/4/2024 N/A Signed Agreement returned to DIR for counter-signature

10/8/2024 N/A

Agreement Approved and Executed – Work begins 10/31/2024

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) email attachment containing ONLY the Technical Proposal and all other required elements.

b. One (1) email attachment containing ONLY the Cost Proposal.

c. 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 III, 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. 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 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%

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.

III. PROPOSAL REQUIREMENTS (TECHNICAL) (DO NOT INCLUDE COST PROPOSAL)

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

1. Proposer must have a minimum of five (5) years of experience providing workers’ compensation medical bill review services.

2. Proposer must have a Bill Review Tracking System (BRTS) that can be accessed by authorized DIR users to track status of bills and retrieve other information.

3. Proposer’s bill reviewers providing bill review services for DIR must be certified pursuant to the California Insurance Code section 11761 and California Code of Regulations, Title 10, sections 2592.04. Proposer must complete Attachment 13.

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 must be the same as the title of the RFP.

b. The number of the RFP, S24DWC008; 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 S24DWC008, 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 no 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 the completed attachments listed in Attachment 1, Required Attachment checklist.

8. References

Each proposer must provide at least three (3) references detailing similar services and previous experience in the last five (5) years to projects of same or similar size and scope related to the Minimum Qualifications outlined in the RFP.

The references must be able to vouch for the Proposer’s Bill Review services and ability to create successful partnerships with their clients in providing excellent customer service and in meeting their specific needs.

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. Statement Regarding Confidentiality and Security of DIR Information and Acknowledgement of Confidentiality

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 F, Statement Regarding Confidentiality and Security of DIR Information and Exhibit G, Acknowledgement 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.2, 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 the services requested and 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 services required. A work plan schedule format is provided below:

TASK RESPONSIBLE PARTY

(Prime or Subcontractor)

DATE OF

COMPLETION

Task 1: Medical Bill Review Service

Task 2: Contractor’s Bill Review Tracking System

Task 3: Interface with Utilization Review (UR) Entity

Task 4: Reporting Task 5: Training Draft Report Final Report

d. Personnel / Experience

For this criterion, reviewers will rate I 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 Proposer shall provide the names, qualifications, and experience of their personnel who will be involved in this project. The Proposer shall provide a minimum of five (5) medical bill reviewers. The selected Proposer shall not cause key members of the project team to be substituted without prior written approval of the State.

While experience gained in any jurisdiction qualifies, higher evaluation will be given to experience gained providing the above services in California.

e. 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 RFP No. S24DWC008 Exhibit A, Attachment 1 Page ## of ##

B. Cost Proposal Requirements (DO NOT INCLUDE TECHNICAL PROPOSAL)

The cost breakdown (Cost Proposal) shall be provided as a separate attachment via email. 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 shall submit the proposed rates for the Cost Worksheet in Attachment 10 under the submitted proposal. The rates submitted for each item shall be fixed for the life of the contract awarded through this RFP. The RFP and subsequent contract do NOT authorize any rate increases (COLA, Tiered Rates, or other multiple level rate structures) during the life of the contract).

Travel expenses shall not be reimbursed by the State as a separate line item on the cost sheet. Bidder is expected to include travel costs as an overhead cost included in the rates in the bid price. Most RFPs are for services only; equipment and supplies are not authorized unless specifically cited in the RFP.

DIR’s budget for the proposed contract is limited to $750,000.00. 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

1. Cost Detail

a. Itemized Tasks – Using Attachment 10, Contractor Cost Worksheet Instructions, proposers shall submit their cost proposal detailing their cost for services.

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 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.

After the technical proposals have been evaluated, only those proposals receiving a score of 80 points or higher will move to Phase 3, Cost Proposal Opening and Evaluation.

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.

The Proposal Evaluation Form in Section IV.B.2 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.

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.

2. Proposal Evaluation Form

MINIMUM QUALIFICATIONS Yes No

Proposer must have a minimum of five (5) years of experience providing medical bill review service to Workers’ Compensation organizations.

Proposer must have a Bill Review Tracking System (BRTS) that can be accessed by authorized DIR users to track status of bills and retrieve other information.

Proposer’s bill reviewers providing bill review services for DIR must be certified pursuant to the California Insurance Code section 11761 and California Code of Regulations, Title 10, sections 2592.04.

If any minimum qualifications are NOT met, STOP HERE

1. CLARITY AND ORGANIZATION OF PROPOSAL

Points

Available

Awarded

The proposal is presented in a clear, organized manner.

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 must include methods to measure project progress against the project management plan to maintain project schedule.

3. METHODOLOGY (APPROACH TO WORK)

Points

Available

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 the services requested and 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

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.

5. PERSONNEL / EXPERIENCE

Points

Available

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. The Proposer shall list technical staff (specify staff name) who will be working on the project, including the independent subcontractor. Include their titles, qualifications, a summary of similar work or studies performed, a resume for each technical staff person (including the independent subcontractor), a statement indicating how many hours each professional will be assigned to the Agreement and what tasks each professional will perform.

Proposer demonstrates experience and breadth of knowledge in performing medical bill reviews and developing an electronic bill tracking system as described in Attachment 2, Draft Standard

Proposer shall provide a minimum of five (5) medical bill reviewers who has had at least five (5) years of on-the-job experience adjusting California workers’ compensation medical bills and designated as an experienced medical bill reviewer by such entity.

TOTAL POINTS

Maximum Available

SCORE

C. Cost Proposal Opening and Evaluation (Phase 3)

After the Technical Proposals have been evaluated, only those technical proposals receiving a score of 80 points or higher will move on to Phase 3, Cost Proposal Opening and Evaluation. Those Technical Proposal that receives less than the minimum score of 80 points will not receive further consideration.

1. The Cost Proposal will be publicly opened and read at the date and time specified in Section II.A Key Action Dates. The Agreement will be awarded to the lowest responsive, responsible Proposer meeting the requirements outlined in this RFP.

a. Preferences and incentives will be applied as required to eligible proposals.

Please see Section I., Socio-Economic and Preference Programs.

b. After calculating and applying any applicable preferences and/or incentives, the Proposer with the lowest cost shall be awarded the contract.

D. Proposal Rejection

1. Proposals must be submitted for the performance of all the services as described herein. Any material deviation from the RFP will not be considered and may cause a proposal to be rejected.

2. Proposals must be complete in all respects as required by the RFP. 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 does not accept alternate contract language from a prospective contractor. A proposal with such language will be considered a counter proposal and may be rejected.

3. DIR reserves the right to reject any or all proposals for any reason.

4. Proposals that contain false or misleading statements, or which provide references, that do not support an attribute or condition claimed by the proposal, may be rejected.

If, in the opinion of the State, such information was intended to mislead the State in its evaluation of the proposal, and the attribute, condition, or capability is a requirement of this RFP, it will be the basis for rejection of the proposal.

5. Proposals received past the due date and time specified in Section II.A. “Key Action Dates” will be deemed non-responsive and rejected. Under no circumstances will any proposals be accepted past the date and time stated in Section II.A. All such proposals received past the date and time will not be accepted and will be returned to the Proposer.

E. Selection

1. The Award, if made, shall be to the responsive Proposer with the lowest cost, within the allocated budget.

2. If no proposals are received containing bids offering a price, which in the opinion of DIR is a reasonable price, DIR is not required to award an Agreement (Public Contract Code 10344 (d)), whether it is due to reasonable price consideration or other reason.

3. The prospective Contractor is advised that should this RFP result in an award of an

Agreement, the Agreement will not be in force and no work shall be performed until the Agreement is fully approved by the State, and the Contractor is notified by the DIR Contract Manager to begin work.

4. The Agreement shall be signed by the selected Proposer and returned within ten

(10) business days of receipt. If the selected Proposer refuses or fails to execute the Agreement, DIR may award the contract to the Proposer with the second highest score.

F. Notice of Proposed Award

1. Notice of the proposed award shall be posted on Cal eProcure at https://caleprocure.ca.gov/pages/index.aspx for five (5) business days prior to awarding the Agreement.

2. Proposers have the right to protest the award of DIR Agreements subject to the following grounds, processes and procedures.

a. Proposers may protest the proposed award by filing a notice of protest with DIR and DGS, Office of Legal Services.

b. Protest notices should contain full contact information, including a fax number or email, and must be filed with both offices listed below:

Contracts Section Attention: Manager 2180 Harvard Street, Suite 160 Sacramento, California 95815 Email address: procurement@dir.ca.gov

Department of General Services Office of Legal Services Attention: Bid Protest Coordinator 707 Third Street, 7th Floor, Suite 7-330 West Sacramento, CA 95605 Email address: OLSProtests@dgs.ca.gov

c. Within five (5) calendar days after filing notice to protest, the protesting Proposer shall file with the DGS Office of Legal Services and DIR, a detailed written statement specifying the grounds for the protest. The detailed written statement shall include the RFP number.

d. The Agreement shall not be awarded until either the protest has been withdrawn or the State has decided the matter.

G. Standard Conditions of Service

1. Service shall be available no sooner than the express date set by DIR and the

Contractor, after all approvals have been obtained and the Agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, DIR, upon five (5) days written notice to the Contractor, reserves the right to terminate the Agreement. In addition, the Contractor shall be liable to the State for the difference between Contractor's Proposal price and the actual cost of performing work by the second responsive and responsible Proposer or by another Contractor.

2. All performance under the Agreement shall be completed on or before the termination date of the Agreement.

3. The State does not accept alternate Agreement language from a prospective contractor. A proposal with such language will be considered a counter proposal and may be rejected. The State’s General Terms and Conditions (GTC) are not negotiable. The General Terms and Conditions GTC- 04/2017 may be viewed at Internet site: https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal- Services-Resources-List-Folder/Standard-Contract-Language.

4. The State does not negotiate rates and/or costs listed on any cost proposal submitted.

5. No oral understanding or agreement shall be binding on either party. Any changes or alterations to the contract/agreement must be in writing and approved by both parties and/or Department of General Services’ Office of Legal Services, if required.

H. Post Award Requirements

1. Prior to execution of the contract and at DIR’s sole discretion, the selected Proposer must comply with the following in a manner acceptable to DIR:

a. The Agreement shall be signed by the Contractor and returned within ten (10) business days of receipt. If the Contractor refuses or fails to execute the contract, then DIR may award the contract to the next ranking…