INDIANA DEPARTMENT OF ADMINISTRATION

Physician Services for Medical Chart Review and EvaluationFor the Disability Determination Bureau

REQUEST FOR PROPOSAL 15-009on behalf of the

Family and Social Services Administration

INDIANA DEPARTMENT OF ADMINISTRATION

GENERAL INFORMATION

• Attendee Sign-In Sheet

• Sign-In Sheet and PowerPoint will be posted on State’s Solicitation Website

INDIANA DEPARTMENT OF ADMINISTRATION

RFP QUESTIONS AND ANSWERS

Questions answered verbally today are not official nor binding and should be submitted in writing if it will affect your proposal response (Q/A Template).

• General RFP questions must be submitted to Matt Robinson by fax or email by 3:00 PM Eastern Time on October 1, 2014

Email: marobinson@idoa.in.gov

Fax: 317.232.7312

INDIANA DEPARTMENT OF ADMINISTRATION

ACCESSING RFP DOCUMENTS

www.in.gov/idoa/proc

INDIANA DEPARTMENT OF ADMINISTRATION

ACCESSING RFP DOCUMENTS

INDIANA DEPARTMENT OF ADMINISTRATION

INDIANA DEPARTMENT OF ADMINISTRATION

KEY RFP DATES

INDIANA DEPARTMENT OF ADMINISTRATION

PURPOSE AND SCOPE OF RFP 15-009

Physicians will review computerized and/or paper claims and provide advice as to the severity of the impairment or advise if additional medical evidence is needed in order to make a decision.

They may be required to sign off on testing that may result in potential harm to the claimant, such as a treadmill, arterial blood gases, etc.

Complete Residual Functional Capacity forms for adults, Childhood Disability Evaluation forms for children and/or Case Analysis forms with signature.

Evaluations will be consistent with the guidelines set forth by the Social Security Administration.

All work must be performed at the Disability Determination Bureau’s premises at 2525 N. Shadeland Ave., Indianapolis, IN.

All work also must be done by a contractor that is fully licensed in the profession.

Office space and computers will be made available to contractors as the information in disability claims must be kept secure and protected.

Work off-site is not permitted.

INDIANA DEPARTMENT OF ADMINISTRATION

RFP OUTLINE

INDIANA DEPARTMENT OF ADMINISTRATION

BUSINESS PROPOSALCompany Financial Information (Section 2.3.3)

Confidential information must be kept separate from the proposal in both hard and soft copy.

INDIANA DEPARTMENT OF ADMINISTRATION

TECHNICAL PROPOSAL

INDIANA DEPARTMENT OF ADMINISTRATION

COST PROPOSAL

INDIANA DEPARTMENT OF ADMINISTRATION

MINORITY AND WOMEN’S BUSINESS ENTERPRISE

Complete Attachment A, MWBE Form- Include sub-contractor letters of commitment Goals for this RFP:

- 8% Minority Business Enterprise

- 8% Women’s Business Enterprise

INDIANA DEPARTMENT OF ADMINISTRATION

MINORITY AND WOMEN’S BUSINESS ENTERPRISE

INDIANA DEPARTMENT OF ADMINISTRATION

INDIANA VETERANS’ BUSINESS ENTERPRISES SUBCONTRACTOR COMMITMENT (ATTACHMENT A1)

Complete Attachment A1, IVBE Form- Include sub-contractor letters of commitment

Goal for this RFP: 3%

INDIANA DEPARTMENT OF ADMINISTRATION

INDIANA ECONOMIC IMPACT

The State defines FTE as a measurement of an employee's productivity on a specific project or contract. A FTE of 1 would mean that there is one (1) worker fully engaged on a project; forty (40) hours a week, fifty-two (52) weeks a year. If there are two (2) employees each spending 1/2 of their working time, 20 hours per week, on a project that would also equal 1.

1 Legal Name of firm:2 Address/City/State/Zip Code:3 Telephone #/Fax #/Website:4 Federal Tax Identification

Number:5 State/Country of

domicile/incorporation:6 Location of firm's

headquarters or principal place of business:

7 Name of parent company or holding company (if applicable):

8 State/Country of domicile/incorporation of company listed in #7:

9 Address of company listed in #7:

10 IN Department of Workforce Development (DWD) account number:

11 IN Department of Revenue (DOR) account number:

12 Number of Indiana resident employees per most recently completed IRS Form W-2 distribution:

13 Total number of employees per most recently completed IRS Form W-2 distribution:

14 Total amount of payroll paid to Indiana resident employees per most recently completed IRS Form W-2 distribution:

15 Total amount of payroll paid to all employees per the most recently completed IRS Form W-2 distribution:

16 Administrative amount of this proposal, bid, or current contract.

150,835,903.00$

This information is required by the Indiana Department of Administration for all contractors, vendors/suppliers to the State of Indiana (complete all 22 items).

INDIANA ECONOMIC IMPACT - PROPOSALS AND CONTRACTSState Form 51778 (R4 / 1-06)DEPARTMENT OF ADMINISTRATIONApproved by State Board of Accounts, 2006

INDIANA DEPARTMENT OF ADMINISTRATION

RFP SCORING AND EVALUATION

INDIANA DEPARTMENT OF ADMINISTRATION

QUESTIONS AND ANSWERS

INDIANA DEPARTMENT OF ADMINISTRATION

ADDITIONAL INFORMATIONIDOA PROCUREMENT LINKS AND NUMBERS

http://www.in.gov/idoa/2354.htm1-877-77BUYIN (8946) For Vendor Registration Questions

http://www.in.gov/idoa/2464.htmFor Inquiries Regarding Substantial Indiana Economic Impact

A. Link to the developing “one stop shop” for vendor registry with IDOA and Secretary of State. http://www.in.gov/idoa/2467.htm

B. Secretary of State of Indiana: Can be reached at (317) 232-6576 for registration assistance. www.in.gov/sos

C. Vendor Handbook: Online version available at http://www.in.gov/idoa/files/vendor_handbook.doc

D. Minority and Women Owned Business Enterprises: http://www.in.gov/idoa/files/Certification_List(48).xls for table of IDOA certified MBEs and WBEs. For more WBE’s information http://www.in.gov/idoa/2352.htm

E. RFP posting and updates: Go to http://www.in.gov/idoa/2354.htm (select “State of Indiana Opportunities” link) Drag through table until you find desired RFP/RFI number on left-hand side and click the link.