Medical Review Team (MRT) Request for Proposals (RFP) 08-15

Medical Review Team (MRT) Request for Proposals (RFP) 08-15

Pre-proposal Conference November 10, 2015

11/17/2015 1

Agenda

• Introductions • Ground Rules • Critical Points • Project Overview • Contractor Partnership Program • Small Diverse Business Overview • Timeline • Break/Question Submittal • Questions

11/17/2015 2

Introductions

• Michelle Herring – Bureau of Financial Operations • Merry Mitchell – Bureau of Financial Operations • Faith Ellis – Contractor Partnership Program • Gayle Nuppnau – Small Diverse Business

• Other Commonwealth Staff • Attendees

11/17/2015 3

Ground Rules

• Sign in sheets • Questions may be submitted in writing on the forms

provided by the end of this conference • The Commonwealth team will determine which

questions may be preliminarily answered • Any answers provided are not final until formally

issued in writing • Any changes to the RFP will be issued as a formal

written amendment • Any communication shall be made through the RFP

Project Officer

11/17/2015 4

Critical Points

• To minimize delays in proposal evaluation and to avoid rejection of your proposal, read the RFP carefully and submit a complete proposal, including signature. Evaluations will be based on what is submitted. Follow the proposal format as detailed in Part II of the RFP. Include the appropriate heading descriptions, respond to all requirements and provide any other relevant information as an appendix.

• Each proposal must have three separately sealed submittals; Technical, Cost, and Small Diverse Business. (Please pay close attention to the number of hardcopy and electronic submittals required)

• Do not include any cost data in the technical portion of your proposal. • Proposals must be received by 2:00 PM on Friday, December 4,

2015. • The resulting contract will be for a term of three years. Subject to

performance of the selected Offeror and other considerations, the Department may renew for up to two additional one-year periods.

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Critical Points

• The RFP will be evaluated based on the following criteria: • Technical – 50% • Cost – 30% • Small Diverse Business Participation – 20%

• The technical evaluation will be based upon the following criteria, in order of importance: • Soundness of Approach; • Personnel Qualifications • Offeror Qualifications • Understanding the Problem.

• The total score for the technical submittal of the Offeror’s proposal

must be greater than or equal to 70% of the available technical points to be considered responsible for this RFP.

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Project Overview

• As detailed in Part IV of RFP 08-15, the MRT reviews public assistance consumers’ medical, social, and vocational histories to determine if they can be certified as disabled under Social Security Administration rules and regulations.

• The selected MRT will be responsible for reviewing 2 types of cases: Objective A and Objective B.

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Project Overview

• Objective A cases are cases in which individuals are pursuing Federal disability benefits – Supplemental Security Income (SSI)/Social Security Disability Insurance (SSD). The MRT will provide disability expertise that will assist Disability Advocacy Program staff in pursuing SSI/SSD benefits for public assistance recipients.

• Objective B cases are cases in which disability is determined in order for public assistance/recipients to qualify for a Federal category of Medical Assistance.

11/17/2015 8

Project Overview

• The deliverable to the DAP staff is different depending on whether it’s an Objective A or Objective B case.

• For Objective A cases in which the individual is certified disabled, the selected Offeror must provide a comprehensive report, including vocational assessment. This report must be completed, reviewed and signed by both a physician and vocational counselor.

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Project Overview

• For Objective B cases to establish eligibility for a Federal Medical Assistance category, the MRT must provide a medical summary signed by both a physician and vocational counselor. No vocational report is required.

• For both Objective A and Objective B, the disability determination by the MRT must be completed within 20 calendar days of receipt of the case.

• Offerors must respond to all areas of the work statement and how they will meet all deliverables.

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Contractor Partnership Program

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What is the Contractor Partnership Program? • The Contractor Partnership Program (CPP) was created by

Pennsylvania’s Department of Human Services (DHS) to create additional employment opportunities within the Commonwealth.

• CPP is designed to leverage the economic resources of DHS to create jobs for individuals currently receiving TANF cash assistance by maximizing the recruitment, hiring and retention of those individuals by Commonwealth contractors, subcontractors and grantees.


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Who’s required to participate in the program? All contractors, vendors, organizations, fiscal agents, county

governments etc. that receive funding (25,000 or more annually ) from the Department of Human Services (DHS) or a DHS funded initiative in the form of a contract, grant, memorandum of understanding or other contracting vehicle


11/17/2015 14

What are the Pre Selection responsibilities of the Contractors? • Fully answer all questions outlined in the Contractor Partnership

Submittal section of the this RFP and any applicable BAFO memos • While developing hiring numbers and plans look both company and

subcontractor wide for the full duration of the contract while establishing potential openings to be filled.

Percentages and ranges are not acceptable


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• In recognition of the difficulties contractors may face in hiring TANF recipients due to the specific scope of services of some RFPs; CPP will credit contractors for TANF public assistance hires that are specific to this RFP, any TANF public assistance hires made in their respective organization not specific to this RFP, as well as any (non duplicated) TANF public assistance hires subcontractors make and maintain on behalf of contractors during the life of this contract.

• While Small/Diverse Businesses can volunteer to assist contractors in meeting CPP requirements, Contractors can not require these businesses to hire qualified TANF recipients as a stipulation to partnership on any contract that derives from this RFP.

It should be noted that…


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How can we identify TANF recipients? • Contractors can partner with the local service delivery

providers in their area; Contact CPP to locate an agency within your area.

• Contractors can also work with faith based organizations, host targeted job fairs, post advertisements in newspapers or the internet

• Contractors can post job orders that match “CPP Eligible” TANF recipients via the Commonwealth Workforce Development System (CWDS) Job Gateway


11/17/2015 17

How do contractors identify that candidates are qualified?

• PA contracts with public and private businesses to provide job skills recipients of TANF

• These Employment and Training sites are located in every county in PA

• Sites assist TANF recipients with multiple services including but not limited to; transportation, tools, uniforms and childcare

• Sites are monitored by DHS for performance in job placement and job retention of placements

• Sites have designated CPP contacts to facilitate assisting contractors to make qualified hires and to meet your CPP requirements


11/17/2015 18

What organizations have hired individuals through the Contractor Partnership Program?

• Educational Data Systems Incorporated • Keystone Mercy • Gateway • Logisticare • University of Pittsburgh Medical Center • Health Partners • Aetna Better Health • Community Behavioral Health • Multiple County Commissions Statewide


11/17/2015 19

What type of positions are typically filled by CPP applicants?

Receptionist Janitorial Call Center Operator Care Manager Security Outreach Coordinator Home Health Aides

Outpatient Case Manager Customer/Member Service Representative Data Entry Clerk Help Desk Operator Administrative Assistant Certified Nursing Assistants


11/17/2015 20

What are the reporting requirements for CPP? • Within 10 days of receiving the notice to proceed, Contractors must register

in the Commonwealth Workforce Development System (CWDS). In order to register the selected contractor must provide business, location and contact details by creating an Employer Business Folder for review and approval, within CWDS at HTTPS://WWW.CWDS.State.PA.US.

• Contractors are required to complete and submit the PA 1540 Quarterly Employment Report Form on a quarterly basis to document the number of TANF cash assistance recipients hired for that quarter. These can be submitted electronically via the CWDS website.

• The form must be completed in its’ entirety and forwarded to the Contractor Partnership Program by the fifteenth day of the following month after the quarter ends. If the 15th falls on a weekend or state holiday the report is due the next business day.

• A copy must also be sent to the DHS Project Officer


11/17/2015 21

What are the reporting requirements for CPP? (Cont.)

• All Contractors, regardless of their contract start date, must submit the PA 1540 based on the calendar quarter. If a contract begins in the middle of a quarter the information reported will be based on activity that occurred from the contract start date through the end of the quarter.

• If no activity occurred the form must be completed by stating “No Activity in this Quarter with the Contractor’s comments. This report must be signed by the entity that holds the contract with the DHS; it may not be signed by a subcontractor.

• The information submitted on this report will be audited for its’ accuracy and the findings will be utilized to determine if the Contractor is meeting its’ hiring requirements as noted in the contract.


11/17/2015 22

What are the benefits for hiring via CPP?

• Contractor can utilize PA’s vast Employment & Training Network to assist in training, hiring and retention at no cost

• Contractors may be eligible for tax credits for hiring individuals receiving cash assistance

• It depends on the specific profile of the individual candidate • Information on tax credits can be found at:

http://www.dli.state.pa.us (Search for Work Opportunity Tax Credit) or call 1-800-345-2555

http://www.dli.state.pa.us/


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For General Questions and Information regarding CPP

PA Department of Human Services Office of Income Maintenance

Contractor Partnership Program Health & Welfare Building

7th & Forster Streets, 2nd Floor West

Harrisburg, PA 17105 Phone: 1-866-840-7214

Email: [email protected]

mailto:[email protected]




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For General Questions and Information regarding this RFP

Please contact Michelle Herring

[email protected]

Bureau of Diversity, Inclusion and Small Business Opportunities

(BSBO)

Gayle Nuppnau

DGS, Procurement Liaison


Program designed to encourage participation of Small Diverse Businesses (SDB) in state contracting A Small Diverse Business is a DGS-verified minority-owned business,

woman-owned business, veteran-owned business or service-disabled veteran-owned business.

A small business is a business in the United States which is independently owned, not dominant in its field of operation, employs no more than 100 full-time or full-time equivalent employees, and earns less than 7$ million in gross annual revenues for building design, $20 million in gross annual revenues for sales and services and $25 million in gross annual revenues for those businesses in the information technology sales or service business.


To receive credit for being a Small Diverse Business or for subcontracting with a Small Diverse Business (including purchasing supplies and/or services through a purchase agreement), a Offeror must include proof of Small Diverse Business qualification in the Small Diverse Business participation submittal of the proposal, as indicated in section II of the RFP. Photocopy of its DGS issued certificate entitled “Notice of Small Business Self-

Certification and Small Diverse Business Verification” indicating its diverse status Small Diverse Business(es) must be named including address and phone Letter of intent that specifies the type of goods or services the small diverse business will

provide along with percentage of commitment All Offerors must include a numerical percentage which represents the total percentage of

the work (as a percentage of the total cost in the Cost Submittal) to be preformed by the Offeror and not by subcontractors and suppliers

All Offerors must include a numerical percentage which represents the total percentage of the work (as a percentage of the total cost in the Cost Submittal) to be performed by the Small Diverse business as subcontractors


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Bureau of Small Business Opportunities (BSBO) Verification Letter

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Contact Information Bureau of Diversity, Inclusion and Small Business

Opportunities (BSBO) Ms. Gayle Nuppnau Procurement Liaison

Telephone: (717) 346-3819 E-Mail: [email protected]



Timeline

• The Project Timeline includes: – October 22, 2015 – RFP 08-15 is issued – November 10, 2015 – Pre-proposal Conference – November 18, 2015 - Answers to Potential

Offerors’ questions will be posted to the Department of General Services (DGS) website

– December 4, 2015 – Due date for proposals – Offeror selection and negotiations

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Break/Question Submittal

Break & Question Submittal Questions may be submitted in writing on the

forms provided during this break or at the end of the conference

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Questions

• To date, ? written questions have been submitted by email. • You may submit additional questions today on the forms

provided. • Questions submitted today will be read and a preliminary

response will be provided. • We will not answer any question not provided in writing. • No answer is official until it is answered in writing. • Answers will be posted to the DGS website as an addendum

to the RFP

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RFP #08-15

• This concludes the pre-proposal conference.

• Answers to all questions will be posted to the DGS website at http://www.emarketplace.state.pa.us/Search.aspx

by close of business November 18, 2015.

• No further questions will be entertained or answered

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Project Officer

Michelle E. Herring

Department of Public Welfare Bureau of Financial Operations Health & Welfare Bldg., Rm 402

Harrisburg, PA 17120 mailto:[email protected]

Any contact with the Department concerning

this RFP must be through the RFP Project Officer

11/17/2015 34

RFP 08-15 MEDICAL REVIEW TEAM FOR THE DISABILITY ADVOCACY PROGRAM Questions & Answers

1

RFP Section Question Answer

1

Are there any restrictions on a company that employs providers to perform consultative examinations for Social Security Disability applicants from competing on this procurement?

As indicated in Part II, Section II-4 Prior Experience, a. Corporate Background; Offerors must identify any current contracting or subcontracting relationships that may result in a conflict of interest with the requirements of the RFP.


2

Could you provide the name of the incumbent contractor currently performing these tasks and the contract dollar amount?

Arbor, E&T LLC, DBA Action Review Group. The current contract (4400008518) can be accessed at the PA Treasury website, www.patreasury.gov


3

Regarding the provision of references in sealed envelopes with the response, should respondents provide these in the original only, or should we request additional copies from references for each of the copies of the submission?

The sealed envelopes containing the references should be provided with the original only.


4

What, if any, constraints will the Department of Human Services (DHS) Office of Income Maintenance have in the implementation of the negotiated scope of services?

There are no known constraints to implementing the services as defined in the RFP.


5

What dedicated staff will DHS Office of Income Maintenance provide for this project?

The Department’s Office of Income Maintenance, Operations Support Unit is responsible for the Disability Advocacy Program and Medical Review Team contract.

http://www.patreasury.gov/


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II-10. Cost Submittal

Does the Pennsylvania Medicaid agency claim FFP for all or any portion of the current contract for MRT services? If so, is the rate 50/50 for Objective A activities? Is it 50/50 for Objective B activities? Or are some other rates claimed and if so, what are they?

The answer is not required for an Offeror to submit a proposal for this RFP.


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II-10. Cost Submittal, A. Direct Labor Costs

As the single state agency for Medicaid, will DHS take advantage of the opportunity to claim enhanced Medicaid match (75/25) for skilled medical professional personnel (SPMP) and their directly supporting staff if the offeror is a public agency in a state other than Pennsylvania? 42 CFR 432.2; 42 CFR 432.50.

The answer is not required for an Offeror to submit a proposal.


8 III-4. Evaluation Criteria

How is the Contractor Partnership Program (CPP) scored? Is it considered as part of the scoring of the technical proposal?

The Department does not provide scoring information. See Part III of the RFP for evaluation information.


9

IV-1. Objectives, B. Specific 1. Objective A

Do the DAP workers obtain and forward to the vendor the complete Social Security Administration (SSA) file including any residual functional capacity assessments and psychiatric review technique forms or just the medical information from SSA?

In some cases, DAP staff forward the entire SSA file, including RFC and other SSA forms. In other cases, DAP staff only have medical information available.


10


What are the metrics for measuring vendor accuracy performance for Objective A. cases? We note that the current contract for this work indicates that the incumbent has “an approval rate between 55% and 65%.” Please define how the approval rate is measured. Is it a percentage of DAP referrals recommended for SSA/SSI application or is it a percentage of cases referred by the vendor that are ultimately approved by SSA?

The approval rate is the % of Objective A cases that are certified as disabled by the MRT.


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What percentage/how many Objective A cases are currently recommended by the vendor for appeal?

When the MRT certifies an Objective A case as disabled, the case is recommended for appeal. Currently the MRT certifies 55 – 65% of Objective A cases.


12


What percentage of appealed Objective A cases eventually require testimony by the vendor?

Testimony at an ALJ hearing by the MRT is very rare, <1%. The MRT comprehensive report is used as evidence in an appeal.


13


Does the Objective A caseload include child and/or continuing disability review cases?

Yes, Objective A includes child and continuing disability reviews.


14


What are the metrics for measuring vendor accuracy performance for Objective B. cases? We note that the current contract for this work indicates that the incumbent has a “90% success rate” for Objective B cases, please define how “success rate” is measured.

The approval rate is the % of Objective B cases that are certified as disabled by the MRT.


15


Does the Objective B caseload include “working disabled”, child and/or continuing disability review cases?

Objective B cases include MAWD (working disabled) and children. Continuing disability reviews are Objective A cases.


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IV-2. Nature and Scope of the Project

In regards to training: “….to agencies and organizations that interface with pertinent organizations both within and outside DHS”…could you provide more detail about the training requirements of the vendor, e.g. frequency, location(s), number of new and/or journeyman trainees, organizations who are “other related entities”? Is there a preference for in-person or online training? Is this the same as described in IV.-3 E. Requirements?

Training would be on as needed basis, approximately 1 – 2 times per year. In the past, training requests have been from the Office of Mental Health and Substance Abuse Services and the Office of Medical Assistance Programs. Location and # of attendees is unknown. Preference regarding in person or online is given to the needs of the requesting entity. Training is the same as described in Part IV, Section IV-3, subpart E. Training Requirements.


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IV-2. Nature and Scope of the Project

Will any of the Objective A and/or B documents/case files received in the MRT be in a language other than English and need translation by the vendor? If so, what languages are most prevalent?

Files are in English. If another language, DHS would submit for document translation.


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IV-3. Requirements, B. Personnel Qualifications

This section says that MRT clinical personnel may be located out of state. Is this reference meant to specifically exclude other MRT staff from being located out of state?

The MRT Project Manager must be located in Pennsylvania. Physicians/Vocational Counselors may be outside of the State.


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IV-3. Requirements, D.

1. and 2.

What is meant by the phrase “…information needed to certify disability?” Is this a reference just to incomplete documentation or does it also include cases where the documentation is sufficient but the case cannot be determined or certified as disabled?

Incomplete documentation. Recommendation as to what documentation is needed to certify the individual as disabled.


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IV-4. Tasks, B. Evaluation

Process 1. A. iii.

When referring an Objective A. case back to the DAP worker for more information, may the vendor request the DAP worker obtain a consultative examination (CE)?

No, DAP staff do not have the ability to request a consultative examination. DAP staff may make a recommendation to SSA to purchase a CE.


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IV-7. Contract Requirements—Small Business

Participation

We note that the BDISBO website has listed small businesses in states other than Pennsylvania. Please confirm that this requirement can be met with a BDISBO recognized small business in a state other than Pennsylvania. If yes, will preferential scoring be given to SDB located within Pennsylvania?

No, the SDB requirement cannot be met with a company that is just self-certified as a small business. For Offerors to receive credit companies must be verified as a small diverse business. Yes, Offerors can utilize DGS verified small diverse businesses from other states. No, preferential scoring will not be given to SDBs located in PA. Each SDB participation submittal will be rated for its approach to enhancing the utilization of SDBs in accordance with the priority rankings listed in Part III, Section III-4 C of the RFP.


22

I-12 Proposals Can you confirm that a "redacted copy" of the technical proposal should be on a 3rd separate CD or flash drive and is only necessary if some portion of the proposal is being marked as confidential.

The redacted version should be on a separate CD or flash drive; and is only necessary if the Offeror designates information as confidential proprietary or trade secret protected, in accordance with Part I, Section I-18.


23 I-2 Issuing Office

Can the state confirm that the proposal should be submitted Attn: Daniel Boyd, given that Michelle Herring is listed as the sole point of contact?

Yes, the proposal should be submitted Attn: Daniel Boyd.


24 I-23 Term of Contract

Can the state provide the budget amount set aside currently for this scope of work?

The answer is not required for an Offeror to submit a proposal.


25 Part II Proposal Requirements

Can DHS provide an estimated "Effective Date" for purposes of planning an implementation plan for our proposal?

The estimated effective date of the contract is June 1, 2016.


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Work Statement B - Evaluation

Process

Can the state confirm that there is no TAB 15 even though it references on under subpart A?

Subpart A should reference “Tabs 1 through 14.”


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Process

Subsection: 1.a.i - It is our understanding that to assess if a person meets or equals the severity of a listing impairment it is to be done by a physician or vocational counselor using the medical documentation provided by the DAP. If they do not meet or equal a listing impairment then an assessment is to be completed that assesses the degree of functional impairments as described above. Can you confirm if all assessments are to be completed using medical records provided, or do physicians and vocational counselor need to provide their own face to face evaluations of the individuals?

MRT evaluations are done with medical records provided by DAP staff. The MRT does not have the ability to conduct face to face evaluations.


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Process

Can you tell of the Objective A (individuals pursuing SSI/SSDI) cases referred by DAP on an annual or monthly basis in the last three years, how many received approvals annually?

MRT certifies as disabled 55-65% of Objective A cases.


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Process

Can you tell us of the Objective B (individuals pursuing Federal category MA) cases referred by DAP on an annual or monthly basis in the last three years, how many of those referrals received approvals annually?

MRT certified as disabled 90% of Objective B cases.


30 What is the current term and expiration of the incumbent’s contract? The current contract was for five years and expires August 31, 2016.

RFP Section Question Answer 31 Does the Commonwealth receive an enhanced match of federal dollars if

the vendor is a QIO-like entity? The answer is not required for an Offeror to submit a proposal.


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RFP Section Question Answer 32 How long does it take to get a self-certified certification complete for a

small diversified business? Once a company has submitted all required verification documentation, it will receive an automated notice that the verification process could take between 7-14 days. Companies that are in the process of verification can request that the Bureau of Diversity, Inclusion and Small Business Opportunities (BDISBO) expedite the request for verification by calling 717-783-3119 and asking for the verification department.

RFP Section Question Answer 33 Has the volume of estimated units changed from the current contract year

to the estimated units in the RFP? No. The estimated units are an average of the current contract years.

RFP Section Question Answer 34 Will the Contractor meet with the claimant or will it be a file review only? The MRT does not meet with the

claimant. The decision is based on the medical/vocational file provided by DAP staff.

RFP Section Question Answer 35 What is contained in the case file? The case file varies for Objective A and

Objective B cases. For Objective A, the file contains a copy of the SSA file and any other pertinent medical/vocational documentation. For Objective B cases, the file contains a copy of any medical documentation verifying the individual’s disability. For children, the file could also contain the child’s Individualized Educational Plan (IEP).


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RFP Section Question Answer 36

Could we please have a list of the attendees at the bidders conference

including the name of the companies they are representing? The requested information is provided with this Addendum.

Documents

Medical Review Team (MRT) Request for Proposals (RFP) 08-15