RFP_S24DWC018_Addendum_1.pdf
PDF 625 KB Posted
- Attached to
- Utilization Review Study
- Solicitation number
- S24DWC018
- Issued by
- California
About this file
This is an Addendum #1 containing Questions and Answers for RFP #S25DWC018 issued by the California Department of Industrial Relations (DIR) for a Utilization Review Study. The proposals are due February 27, 2025, at 3:00 PM and must be emailed to procurement@dir.ca.gov with copies to wluong@dir.ca.gov and klanterman@dir.ca.gov. The study aims to evaluate the impact of medical treatment within the first 30 days after a workers' compensation claim is filed, as mandated by Senate Bill 1160 and Assembly Bill 2848.
The addendum clarifies that DIR's Division of Workers' Compensation (DWC) currently does not collect or maintain any utilization review (UR) data, though they are working with DIR IT to build an electronic reporting system. When operational, this system will collect UR data at the claim and treatment request level through secure electronic transmission from Utilization Review Organizations. The addendum also confirms that DWC will provide contractors with no-cost access to ACOEM licenses for incorporating treatment guidelines into their study.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_S24DWC018_Final.pdf |
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Text version
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) Questions and Answers Addendum No. 1
February 20, 2025
DIR RFP # S25DWC018 – Utilization Review Study
Below is a compilation of the written questions and answers for the above referenced RFP.
Please be reminded that the deadline to submit your proposal will be on February 27, 2025 at 3:00 PM. All proposals must be emailed to procurement@dir.ca.gov cc: wluong@dir.ca.gov and klanterman@dir.ca.gov.
1. RFP states that SB 1160 “mandates electronic reporting of utilization review data by claims administrators to the DWC, which will enable the division to monitor claim processes and address problems.”
a. Is this electronic reporting done via EAMS or another platform? If another platform, which one?
ANSWER: SB 1160 requires DWC’s Administrative Director to develop a system for the electronic submission of information on each UR decision to DWC. The proposed system requires the secure electronic transmission directly from the Utilization Review Organizations (UROs) to DWC. Through the monitoring of this UR data, the division will be able to accurately assess timelines of requests for treatment, determine the effects of the MTUS clinical guidelines on treatment, and compare URO decisions on treatment to assess program consistency. DWC is currently working with the DIR IT Unit to design and build this electronic reporting system, but at the present it is not operational.
b. Is reporting required at the claim or treatment request level, or at a more aggregated level?
ANSWER: It is envisioned that when the UR reporting system is operational it will collect UR data at the claim or treatment request level.
2. Does DWC receive information about requests for authorization (RFAs) for all claims or treatment requests from claims administrators?
ANSWER: Currently, DWC does not receive or collect RFA data. DWC does review RFAs when conducting audits or investigations, but it does not have a database of RFA data.
3. Does DWC receive information on outcomes of UR (e.g., approved, modified or denied) for all claims or treatment requests?
ANSWER: Currently, DWC does not receive or collect UR outcomes (approvals, denials, and modifications). As indicated above, DWC does review UR outcomes when conducting audits or investigations, but it does not have a database of outcomes.
STATE OF CALIFORNIA GAVIN NEWSOM, Governor
Department of Industrial Relations Business Management Office – Contracts Unit 1515 Clay Street, Suite 301 Oakland, CA 94612
4. Does DWC collect UR data at the bill or claim level?
ANSWER: DWC does not currently collect UR data.
5. Would the contractor have access to a free ACOEM license, or would contractors seeking to incorporate treatment guidelines need to include the cost of an ACOEM license in their budgets?
ANSWER: DWC will arrange no cost access.
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