RFP 27-3001 - Workers Compensation Third Party Administrator

The California Department of Social Services is requesting proposals for a Workers Compensation Third Party Administrator under RFP 27-3001, with proposals due November 30, 2026 at 2:00 PM PT. A DVBE participation goal of at least 3 percent applies; proposers claiming DVBE participation receive a bid incentive adjustment ranging from 1% to 5% depending on confirmed DVBE participation level, capped at $100,000 total when combined with other preference adjustments.

The scope encompasses workers' compensation claims administration for three state programs—IHSS/WPCS, CalWORKs, and CalFresh E&T—including claims processing, record management, managed care coordination (bill review, nurse case management, field case management, and utilization review), and data transition from current legacy systems (Claims Connect and Focus) by December 1, 2027. Proposers must hold a California Workers' Compensation Self-Insurance Administrator Certificate and maintain at least one dedicated California office for claims administration. Minimum qualifications include five years of workers' compensation claims administration experience in the last eight years, a paperless claims/risk management system with online access for the State, and three references from large California public entities with similar claimant volumes.

The contract base term runs December 1, 2027 through November 30, 2030, with one optional three-year extension. Implementation and transition services are provided at no cost between June 1, 2027 and November 30, 2027. The cost proposal consists of annualized flat-rate administration and storage fees (Section A) plus unit-based managed care service pricing (Section B) based on FY 2024/2025 historical volumes. Cost evaluation carries 180 of 420 total technical proposal points. Additional evaluation categories include management and staffing (40 points), claims administration (24 points), implementation and transition plan (40 points), workers' compensation program claims management (52 points), claims management information system (36 points), managed care services (72 points), litigation management and cost containment (36 points), and disaster recovery, data security, and compliance factors (68 points combined).

Proposers must submit California Civil Rights Laws certification, Iran Contracting Act certification (required for contracts valued at $1 million or more), Darfur Contracting Act certification, DVBE declarations if applicable, payee data record (STD 204), Bidder Declaration form (GSPD-05-105), subcontractor references (three per subcontractor, with one required from prior CDSS contracts exceeding $10,000), minimum qualifications certification, and Target Area Contract Preference Act documentation if claiming TACPA preference. Failure to complete required attachments may result in proposal rejection as nonresponsive.