Utilization Review Study
Closed State & local contract opportunity Posted
- Solicitation number
- S24DWC018
- State
- California
- Responses due
Opportunity facts
- UNSPSC code
- Point of contact
-
- Winson Luong wluong@dir.ca.gov
Opportunity details come from caleprocure.ca.gov. Updated .
About this opportunity
The California Department of Industrial Relations (DIR), specifically the Division of Workers' Compensation (DWC), is seeking an independent research organization to conduct a comprehensive Utilization Review (UR) Study as mandated by Senate Bill 1160 and Assembly Bill 2848. The primary objective is to evaluate the impact of medical treatment provision within the first 30 days after a workers' compensation claim is filed, focusing on addressing reported challenges with UR processes. The contractor will be required to review Workers' Compensation Information System data, develop a robust research methodology, and provide detailed recommendations to DIR. Key deliverables include monthly progress reports, quarterly teleconferences, and draft and final reports analyzing UR practices. The procurement follows a competitive RFP process (RFP #S24DWC018) with proposals due on February 27, 2025, at 3:00 PM, to be submitted via email to procurement@dir.ca.gov. The evaluation criteria include an administrative review, a technical evaluation weighted at 70 points, and a cost evaluation weighted at 30 points, with a minimum score of 70 points required for award consideration. The contract term is 12 months, with work expected to commence around May 1, 2025.
The procurement includes several enterprise opportunities and incentives, specifically a Disabled Veteran Business Enterprise (DVBE) program offering incentives ranging from 1% to 5% based on DVBE participation levels, though no minimum participation is required. A Small Business preference of 5% is available for certified small businesses or non-small businesses subcontracting 25% to certified small businesses. The total budget for this contract is capped at $300,000, with proposals exceeding this amount considered non-responsive and ineligible for award. The DWC currently does not collect or maintain UR data but is developing an electronic reporting system that will collect data at the claim and treatment request level through secure electronic transmission from Utilization Review Organizations. To support the research, DWC will provide contractors with no-cost access to ACOEM licenses for incorporating treatment guidelines into their study. Potential respondents should be prepared to conduct a deep, thorough analysis of workers' compensation medical treatment practices, with a focus on understanding and potentially improving the UR process for injured workers and medical providers.
Opportunity text
Recently, Utilization Review (UR) has become an increasingly notable area of concern from a variety of stakeholders. Specifically, both injured workers and medical providers report delays and denials of medical care due to the UR process. While existing research does not support the argument of significant delays or denials due to UR, other studies suggest that, while such delays and denials may not be system-wide, they may be specific to certain employers or UR entities. This signifies, in part, that the implementation of best practices across the system will lead to improvements for injured workers who are having their care delayed or denied. Senate Bill 1160 and Assembly Bill 2848 requires the Division of Workers' Compensation (DWC) to contract with an outside independent research organization to evaluate and report on the impact of provision of medical treatment within the first 30 days after a claim is filed. SB 1160 also requires employers to establish a utilization review process that, in addition to meeting specific criteria, shall prospectively, retrospectively, or concurrently review and approve, modify, delay or deny treatment recommendations by physicians. The bill reduces utilization review requirements in the first 30 days following a work-related injury. It also 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. SB 1160 seeks to address the reported challenges with UR in two ways. First, it eases the requirements of UR within the first 30 days of a worker's injury, with certain exceptions. Employers are still able to conduct retrospective review, and SB 1160 provides tools to employers in the event that a medical provider abuses the workers¿ compensation system. In relevant part, both SB 1160 and Assembly Bill 2848, as related to medical treatment that is provided through a medical provider network (MPN), a health care organization (HCO), other employer directed provider, or a pre-designated physician, requires that no prospective UR may be undertaken for the first 30 days of treatment and requires any treatment provided within the first 30 days to be reported to the employer or claims administrator. ------------ 2/20/2025: Posted Addendum 1
Files
| File | Type | Posted |
|---|---|---|
| RFP_S24DWC018_Final.pdf | ||
| RFP_S24DWC018_Addendum_1.pdf |
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