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21-129 - Third Party Administration of Workersâ€™ Compensation and Accidental Disability Retirement Medical Ser

End date: Monday March 29, 2021 at 2 p.m.

Third-party administration services by the Contractor shall consist of claims administration, claims monitoring, medical case management, utilization review (UR) according to 452 CMR 6.0 et al, vocational rehabilitation case management, and medical case management to and through resolution of all active past, current and future claims and cases. The services shall include: receipt, processing, filing and maintenance of all claim-related forms, reports and notices as required by state law for controlling losses; utilization review (UR) and verification of all medical services billings, including medications and durable medical equipment, and determination of lowest state authorized rate for payments by the Contractor on behalf of the City, including claimants granted accidental disability retirement (ADR); timely follow-up with licensed health care professionals and claimants and investigation of cases, when necessary, to reduce exposure and cost; management of return to work and modified work programs; vocational rehabilitation case management; and recommendations of appropriate claimant’s earning capacity status for final decision by the City. Administration should also include the incorporation of the appropriate number of nurse case managers to effectively provide assistance in monitoring injured employees’ medical care and treatment and to issue basic reports to claims handlers assigned to the City account, the Human Resources and Labor Relations Department (HRLRD) and affected department managers as outlined in this RFP.

Administration of claims by the Contractor shall include receipt, processing, filing, and maintenance of all relevant claims, all contact with claimant employees and their legal representatives, all parties involved in treatment and rehabilitation, potentially provide representation by a competent person at conciliations before the Department of Industrial Accidents (DIA). The administering Contractor must be capable of providing the City and, when and as required, the DIA or any other state agency, with timely and appropriate reports as required or requested by the City in a format and electronic media that are acceptable to the City.

The administering Contractor shall work with and report to the City’s HRLRD and shall cooperate with covered departments of the City in analyzing causes of accidents and their associated injuries and shall provide written loss control recommendations to the City in their efforts to reduce the number of accidents. The Contractor shall manage initiatives to return claimants to work or modified work. The Contractor shall cooperate with the City’s Law Department and any other party acting as a legal representative of the City.

Minimum Qualifications

All proposals shall be evaluated in conformity with the requirements of Massachusetts General Laws, Chapter 30B procurement regulations. An Evaluation Committee comprised of representatives from the Springfield Human Resources and Labor Relation Department and other appropriate representatives will evaluate the proposals received. The Selection Committee will use both Minimum Evaluation Criteria and Comparative Evaluation Criteria to evaluate proposals.

To be eligible for the Third Party Administration (TPA) contract and oversee the City’s self-insurance for the purposes of M.G.L. Chapters 152 and 32 ADR, the bidder shall demonstrate experience in the administration of M.G.L. Chapter 152 and associated state regulations as outlined in this RFP. The bidder awarded the contract shall provide the following from a Surety licensed to do business in Massachusetts:

1. Within thirty (30) days of notification by the City that the Contractor will actually be making payments (as detailed in the scope of services) on behalf of the City for indemnity, fees, agreements and/or medical services, the Contractor shall post a payment/performance bond for payment services provided to the City in the amount of $1,000,000.

2. Prior to the execution of the contract, the Contractor shall provide a certificate of insurance in the amount of $1,000,000 per occurrence and $10,000,000 in the aggregate and outlining policy limits and information relative to Errors and Omissions coverage and who is covered within thirty (30) days of the bid award by the City.

The bidder, as well as each of its employees providing TPA services to the City, shall be duly licensed, registered or otherwise qualified, if so required by Massachusetts law or regulation, to perform the services described in this RFP.