Quality Assurance Review of Disability Cases

The RRB is issuing this Request for Information (RFI) to obtain information including pricing estimates from interested vendors for Quality Assurance Reviews of Disability Cases.

1. Cases Reviews

The RRB performs annual quality assurance reviews of 72 initial disability determinations. This review begins the second week of January and is finished on or before April 30TH. Additional Case follow up may occur on a limited and ad-hoc basis through September 30th.

There are two separate reviews being conducted each fiscal year:

1. The Board Order 20-37 review of 10 initial disability determinations. This review begins November 1st and is finished on or before December 16th.

2. The annual quality assurance review of 72 initial disability determinations. This review begins the second week of January and is finished on or before April 30TH.  Additional Case follow up may occur on a limited and ad-hoc basis through September 30th.

At a minimum, a proposed QA Review of Disability Cases shall have:

1.   Medical Staff Qualifications

a. The contractor shall ensure that all physicians performing services under this contract shall (a) be currently licensed in the State in which contractual services are rendered and shall (b) have training and experience necessary to perform the required contractual function.

b. The Contractor shall provide physicians conversant with the various regulations, policies and guidelines related to disability-based benefits under the Railroad Retirement Act and the Social Security Act as each of those Acts are currently stated and as each Act may change during the lifetime of this contract.

c. The RRB will provide the contractor with the various regulations, policies and guideline required for contract performance.

d. No physician performing services under this contract shall have served as a witness in a lawsuit either against or for a railroad employer, or be an employee of a railroad, of the RRB, or subcontractor of an RRB contractor for disability related examinations services. In addition, no physician shall perform services under this contract for any case where they have provided medical exams, opinion or RFC assessments as a treating or consulting physician.

e. The Contractor shall not employ, under this contract, the services of any individual or entity who is excluded, suspended, or otherwise barred from participating in Medicare, Medicaid or any other Federal or Federally-assisted program.

2. Quality Control Plan – Must be able to provide, as part of any subsequent solicitation, the ability to maintain an ongoing quality control plan to ensure that the requirements of this contract are satisfied. The plan shall include methods for identifying, resolving, and preventing deficiencies in the quality and timeliness of services performed under this contract to ensure the level of performance meets the contract requirements.