Pre-ProposalConference Speaking Points

Background. The Commonwealth of Pennsylvania is self-insured for workers’ compensation coverage. Although the commonwealth is self-insured, we do not administer our claims. This RFP is to obtain a claims administrator for the workers’ compensation claims of employees working for a commonwealth agency. The offeror will work with the Office of Administration staff as well as staff in each of the agencies covered by the program, which are listed in Appendix C of the RFP, and the offeror must be able to perform or procure all aspects of workers’ compensation claims administration.

Critical Points in the RFP. To minimize delays in proposal evaluation and to avoid rejection of your proposal, read the RFP carefully and submit a complete proposal. Our evaluation will be based almost entirely on what is submitted by you. Follow as completely as possible the proposal format given in Part II of the RFP; this will aid us in making our evaluation.

Based on observations from the questions received and issues that we want offerors to fully understand before providing a proposal, we are sharing the following information.

  1. Please define the terminology that is used within the RFP response. Do not assume the reviewing committee members have the same understanding of terms that are used routinely in your organization. For example, medical management can includedifferent levels of management and may include different services which may not be apparent to the committee.
  1. Most of the tasks in the RFP seek the offeror’s best proposal, rather than dictating a specific approach. However, some tasks must be completed as requested. For those required tasks, instead of simply responding with a statement such as “we can do that”,please explain how the service will be performed or provide experience in performing the task. This will demonstrate to the committee that you fully understand the requirement, which may generate more points to be awarded than what would be awarded for a simple “yes” response.
  1. Offerors should be creative in the solutions provided (reference Reference I-16, Alternate Proposals, of the RFP). The Issuing Office has identified the basic approach to meeting its requirements, allowing offerors to be creative and propose their best solution to meeting these requirements. The Issuing Office will not accept alternate proposals. Nevertheless, (reference II-3, Work Plan) modifications of the task descriptions are permitted; however, reasons for changes should be fully explained. If more than one approach is apparent, comment on why you chose a specific approach.
  1. The previous procurement and current contract includes a component for safety services. A separate procurement will be sought for this service; however, offerors must agree to provide data to the selected safety vendor and exchange information about injury trends.
  1. The previous RFP and current contract have similar tasks as requested in this procurement. However, when an offeror reviews pricing and staffing models of the current contract, be aware that they may not be appropriate for this procurement, even for the incumbent vendor, since there are some differences between this procurement and the current contract.
  1. The Instructions for the Cost Proposal Worksheet require bidders to determine a per claim charge for the life of the claim. No other claim fees will be paid to the vendor. There are several examples provided within the Instructions to describe the services that should be included in the cost per claim fee and those that may be billed as an allocated claim expense. Most allocated expenses must be approved by the agency workers’ compensation coordinator. An allocated expense includes services not typically performed by adjusters. These are generally services involving direct, face-to-face interactions with claimants or involving a comprehensive review of records to provide an expert opinion. This would include, but not be limited to, the following services: surveillance and activity checks, vocational rehabilitation, field nurse case management, and independent medical examinations. When this type of service is approved by an agency workers’ compensation coordinator, the offeror will schedule the service at no charge and authorize the payment to the vendor who completed the actual expense service through the payment authorization process described in the RFP. There are no provisions to pay the offeror any fees related to procuring the service; allocated claim expenses may only be authorized for the service itself. Keep in mind that contractual relationships with any vendor hired to procure these types of services must be shared with the commonwealth.
  1. Services for medical bill review and repricing must be included in the cost per claim fee. No additional fees may be authorized to a vendor for processing medical bills.
  1. The offeror may not charge any fees to prepare for the implementation of the contract, except for the one fee that is provided on the Cost Proposal Worksheet to transfer existing electronic claims data. Costs for developing and testing interfaces will be the responsibility of the offeror.
  1. For prescriptions related to injuries, most employees use their commonwealth-issued Medco card and pay the co-payment. The process of reimbursing the claimant for the co-payment and the Pennsylvania Employees Benefits Trust Fund is detailed in Appendix G. The commonwealth chose this approach rather than the use of a pharmacy program specific for work-related injuries because of the significant discounts provided to the commonwealth through the contract with Medco. However, many long-term claimants no longer have a Medco card, which represents about 70% to 75% of prescriptions paid. Therefore, a pharmacy benefit solution for this group is being sought.In IV-4 f. ii), mentions that additional details will be provided as part of an addendum. Appendix U and V will be made available by November 2, 2011. Appendix U will include the NDC#, drug name, quantity filled, and fee schedule amount. The Cost Proposal Worksheet will be amended at the same time to include a line item providing a guaranteed savings for this group. Appendix V is provided for reference only to show the prescriptions costs that are being reimbursed to a claimant.