Quality Assurance Review : Initial Disability Determination

SEE ATTACHED RFP AND ATTACHMENTSThis is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation.Proposals are being requested and a written solicitation will not be issued. The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2005-75. This Request for Proposal (RFP) number RRB20R0002 is issued to request proposals for a Contract or a Delivery Order for Quality Assurance Review: Initial Disability Determination. Please see the attached RFP document for the Statement of Work (SOW), Clauses and Provisions, Quotation Submission instructions, and Quotation Evaluation and Award information. This RFP is issued as unrestricted.OVERVIEWA. Agency Information: The U.S. Railroad Retirement Board (RRB) is an independent federal agency that administers a

retirement and survivor benefit program for railroad employees and their families. The RRB was established by the Railroad Retirement Acts of 1937 and 1974. Its benefit program was the forerunner of the more familiar social security system. The Railroad Retirement System is unique inasmuch as it is the only federally administered benefit program covering a single private industry. The RRB also administers the Railroad Unemployment Insurance Act which provides unemployment and sickness benefits to railroad employees. The RRB's headquarters and the RRB's Office of the Inspector General are located in Chicago, Illinois. The RRB also has 53 field offices, nationwide.B. Objectives: The RRB seeks to procure Quality Assurance - Case Review services for initial disability determinations performed by the RRB, as specified in Sections II., and Section III, Statement of Work (SOW) below.C. Questions pertaining to this solicitation must be submitted in writing and received by this office in sufficient time to allow the timely transmission of written answers by solicitation amendment. To ensure this, the RRB will only answer questions received inthis office no later than 2:00 PM Central Standard Time (CST), November 18, 2019. Questions pertaining to this solicitation must be submitted to: proposals@rrb.gov or hasael.roman@rrb.gov, and the e-mail subject line must reference the RFP number os this solicitation.D. Offers are due no later than 2:00 PM (CST), December 9, 2019 and must be submitted to proposals@rrb.gov, and the e-mail subject line must reference the RFP number listed on the solicitation.III. STATEMENT OF WORKQuality Assurance Review: Initial Disability DeterminationsA. Description of Quality Assurance Review ServicesClaims Related Services - The Contractor shall provide licensed physicians who are knowledgeable and conversant with the many and varied fields of medicine. The contractor shall organize and train physicians and staff for all functions under this contract.1. The contractor shall provide an assessment of the appropriateness of limitations [Residual Functional Capacity] or severity impairment [Listing Leve] based on objective medical evidence, along with supporting medical exams and opinions included in the applicant's record.a. The Contractor shall review each disability case file material to determine if the limitations[Residual Functional Capacity] or severity impairment [Listing Leve] used in the initial disability decision is supported by medical evidence of record. The Contractor shall review all medical evidence received in support of the disability application.b. The Contractor shall review a stratified sampling of seventy-two cases including:(1) Occupational cases - 31 grant decisions and 1 denial decisions(2) Total cases -24 grant decisions and 5 denial decisions(3) Widow(er) cases - 4 grant decisions and 1 denial decisions(4) Children cases - 5 grant decisions and 1 denial decisionsc. Each individual review case will be assigned a unique ID case number. The assigned case numbers will range from number 1 through 72. The Contractor will receive up to three (3) pdf documents for each case, including: 1. the disability application 2. medical evidence, and 3. vocational reports.d. The Contractor must complete the required Access data entry form for each case reviewed. See Attachment A for the information that is required for each case reviewed by the Contractor. The RRB will provide the Access database will be provided to the Contractor via secure email.e. The Contractor's assigned reviewer cannot have previously worked on or handled (i.e., provided a medical exam or opinion) for any of the seventy-two selected cases for review.2. The Contractor shall complete a minimum of eight quality assurance reviews each week. Eight cases per week for nine consecutive weeks.3. On a weekly basis (each Friday by 6:00pm CST) the Contractor shall provide a current copy of their Access database to the RRB COR via encrypted e-mail, with the case review elements for all cases reviewed.4. The contractor shall complete all 72 cases within nine weeks of the date the RRB assigns the contractor the first eight cases. Please see due dates based on the Case Review End Date in the Schedule of Review chart shown in Section II.B. #1.5. The contractor shall meet the weekly quota of completed cases. (See B.2 & 3 above)D. Medical Staff Qualifications1. The contrator shall ensure that all physicians performing services under this contract shall (a) be currently licensed in the State inwhich contractual services are rendered and shall (b) have training and experience necessary to perform the required contractual function.2. The Contractor shall provide physicians conversant with the various regulations, policies and guidelines related to disability based benefits under the Railroad Retirement Act and the Social Security as each of those Acts are currently stated and as each Act may change during the lifetime of this contract.a. The RRB will provide the contractor with the various regulations, policies and guideline required for contract performance.3. No physician performing services under this contract shall have served as a witness in a lawsuit either against or for a railroad employer,or be an employee of a railroad, of the RRB, or subcontractor of an RRB contractor for disability related examinations services.In addition, no physician shall perform services under this contract for any case where they have provided medical exams, opinion or RFC assessments as a treating or consulting physician.4. The Contractor shall not employ, under this contract, the services of any individual or entity who is excluded, suspended, or otherwise barred from participating in Medicare, Medicaid or any other Federal or Federally-assisted program.E. Quality Control Plan - The Contractor shall maintain an ongoing quality control plan to ensure that the requirements of this contract are satisfied. The plan shall include methods for identifying, resolving and preventing deficiencies in the quality and timeliness of services performed under this contract to ensure the level of performance meets the contract requirements.F. Quality Assurance Plan - The RRB shall use the following methods to ensure that the RRB receives the quality of service specifiedin the contract.C. Business/Price Proposal -1. The offeror must submit one (1) signed and dated offer, electronic submission only, to proposals@rrb.gov, at or before the exacttime specified in this solicitation. Offers must be submitted on the SF-1449, page 1 of the RFQ, with blocks 17(a), 17(b), 30(a), 30(b), & 30(c) completed. Offeror must complete Price Schedule, Section II (providing firm fixed unit pricing), and fill-ins, Sections II. B, & II.C.2. Offeror must complete Contractor Information for Order Administration (See section II. C), Offeror Representations and Certifications, and System for Award Management (SAM) registration to be considered for award.3. Signed copies of any amendments issued for this solicitation.Note: Offeror Representations & Certifications may be completed in conjunction with SAM registration at www.sam.gov.D. Technical Proposal -As described in and related to Section III, SOW, above: Technical proposals that are unrealistic in terms of commitment, lack competence, or are indicative of failure to comprehend the complexities of the solicitation requirements will be rejected.The technical proposal shall not make any reference to cost or pricing data. Offerors shall submit an electronic copy of their Technical Proposal with sections in the same order as the following outline and shall be titled the same.1. Introduction (5 pages or less)The contents of the proposal introduction shall be determined by the offeror but should include the following:a. A management summary that provides a general background and organizational table of the company (corporate or business name, administrative address, appropriate business licenses or certifications) and any impending, current or recent litigation or sanctions that the offeror has been involved in which might have an impact on this contract;b. A general statement and discussion of the Contractor's responsibilities as understood by the offeror; andc. A statement and discussion of the contractor's approach and any anticipated major difficulties and problem areas, in meeting the prescribed time frames, and establishing adequate safeguards.2. Claims-Related ServicesEach offeror shall include in its proposal a comprehensive plan for performing all functions outlined in Section III.A. This plan shall include:a. How the offeror will plan to review the railroad retirement disability cases;b. How the offeror will plan for reviewing medical evidence in the disability cases;c. How the offeror will plan to determine if the Limitations [Residual Functional Capacity] or severity impairment [Listing Level] used in the initial disability decision is supported by medical evidence of record ;d. How the offeror will recruit and maintain qualified physicians in the variety of fields of medicine;e. How the offeror will train these physicians in policy, regulations and guidelines under the Railroad Retirement and Social SecurityActs and as they may change during the lifetime of the contract;f. How the offeror will complete the Access database;g. How the offeror will satisfy or better the time frames for completing the quality assurance review for each disability case SectionsIII.B.1, B.3, and B.4;h. How the offeror will plan for availability of follow-up discussions after the case review is complete.3. Claims Handling and SecurityOfferor's shall provide the address(es) of the off-site location(s), where the services will be provided. The offeror shall also furnish adetailed plan which would address the following topics.a. Ensuring the privacy, confidentiality and safety of electronic case files while they are in the possession of the Contractor (ref: SectionIII.C.2.)b. Identification of a contract liaison, and alternate, and their qualifications (ref: Section III.C.3.)4. Personnel Staffing and QualificationsEach offeror shall include in its proposal the following: (ref: Section III.D.)a. Detailed resumes describing the qualifications of each and every professional employee that would perform the services requiredunder this contract. Resumes submitted with the technical proposal shall describe, in detail, all capabilities, education and experiencepertinent to the work required by this solicitation. This shall include explicit experience in reviewing RRA and/or SSA disabilitycases. This shall also include explicit experience reviewing in reviewing private insurance, workman's comp, or other 3rd party disabilitycases. This shall include experience related to peer review, evaluation of the individual's ability to function in a work environment, the ability of an individual to communicate medical facts in lay terms and experience and knowledge of the rules and regulations under the RRA and SSA disability programs.5. Quality Control PlanEach offeror shall include in its proposal a detailed quality control plan (See section III.E) to ensure that the requirements of its qualitycontrol review process for the performance requirement specified in Section III.A. are satisfied. The plan shall include methods foridentifying, preventing and correcting deficiencies in the quality of service performed under this contract.6. Corporate Experience/Past PerformanceSpecific past performance information shall be presented.a. The offeror shall submit, as part of its proposal, information on a minimum of three (3) previously performed contracts or ongoingcontracts performed for Federal, State, or local Government and for commercial firms that are very similar to the services required inthis solicitation. The offeror shall describe the scale and extent of their experience to include a description of the solutions and explainhow these projects relate to the technical services required in this solicitation in order to demonstrate specific previous experience doingthe same type of work. The information may also include a description of any quality awards earned by the offeror.b. The Government will place greater value on experience that is directly related to the requirements of this solicitation including reviewof Railroad Retirement Disability Cases and/or Social Security Administration Disability Cases. All directly related experienceshould be discussed. Proven, verifiable, experience that is most directly comparable to the requirements of this solicitation will be consideredof greater value to the government. For each project described, the offeror shall:1) Include the contract, task order and/or identification number.2) Task dollar value.3) Customer organization name and location.4) Customer points of contact with phone numbers, emails and titles to allow verification of the information.5) Ensure that the information presented for contact points is accurate and current.c. Offerors shall have their customer references directly submit to the RRB, Past Performance Questionnaires (PPQ), Attachment B,from a minimum of three (3) and maximum of five (5) references. Questionnaires will be used to collect performance informationabout the offeror from existing and/or prior clients. The references may submit the completed questionnaires via email toproposals@rrb.gov. The RRB may schedule by the due date and time for offers (See section IV.B)a follow up conference call withthe references, post PPQ completion, to discuss in greater detail the services provided by the offeror and the references' satisfactionwith the services.d. The Government will not attempt to ‘track down' supplied past performance references in cases where inaccurate reference informationis provided. Incomplete or inaccurate reference information may lead to a lower evaluation score.e. The Government may supplement the information you provide with any other information it may obtain from any other source, includingits own experience with your firm or information concerning your performance from other reliable sources.Section VI - Evaluation and AwardA. The Government will award a contract resulting from this solicitation, based on price and technical factors incluing past performance,to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government.The Technical evaluation shall be weighted significant greater than the Price evaluation.The following factors shall be used to evaluate offers:B. PRICE PROPOSAL EVALUATION -1. The RRB will evaluate Offeror's Total Evaluated Price (TEP) proposal as the sum of the extended amounts in CLINs: 0001 through0005 for the services as stated in Section II, Price Schedule. Offers received without pricing for these CLINs shall be considered noncompliantto the solicitation and the RRB shall not further evaluate such proposal.Document Number: 60RRBH20R0002 HELD Page 20 of 222. Scoring the TEP: RRB will score the Offeror's total evaluated price (TEP) as follows: Calculation of the price score (100 maximum)will be computed by multiplying the maximum score available by (100) by a fraction representing the ratio of the lowest totalevaluated price of all technically acceptable responsive offers received (numerator) by the RRB to the total evaluated price of the givenoffer being evaluated (denominator). Price Score = (100) * (lowest offered TEP/Evaluated Offeror TEP).C. TECHNICAL PROPOSAL EVALUATION -In order for offeror's proposal to be considered compliant, the RRB will first review technical proposals for conformance with proposalpreparation instructions (ref: Section V.). Proposals which the RRB Contracting Officer deems to be deficient in this area may berejected without further consideration.Statements such as "The Offeror understands", "standard procedures will be employed", "well known techniques will beused", and general paraphrasing of the statement of work (SOW) shall be considered inadequate and/or non-compliant. Thetechnical proposal must provide details concerning what the offeror will do and how it will be done. This includes a full explanationof the techniques, disciplines, and procedures proposed to be followed. Offers received that have such above or similarlyvague statements shall be rated accordingly.a. The government will evaluate, conforming to the solicitation, the following factors demonstrating the offeror's ability to successfullyperform the requirements of the contract.b. The RRB will evaluate the Quality Assurance Review Case Services proposals considering the following technical factorsin descending order of importance. Subfactors are not listed in descending order of importance.1. Claims-Related ServicesThe RRB wll evaluate how the offeror plans to render complete disability quality assurance case reviews, including: review of medicalevidence, determination if Limitations are supported by the medical evidence, completion of the Access database, and completing casereviews within the prescribed nine week timeframe. Offerors must describe their capability to provide subsequent support for followupcase discussion after the nine week case review services are completed for a given peformance period. Offerors must also describehow they will recruit, maintain and train their medical staff.2. Claims Handling and SecurityTh RRB will evaluate how the offeror explains where services will be rendered and its plan to safeguard and monitor the electronicfiles and their contents while in the offeror's possession. RRB will also evalute the capabilities of the the offeror's to identify a contractliaison and alternate for the daily operation.3. Personnel Staffing and QualificationsRRB evaluation will be based on staffing and will include an evaluation of medical personnel and, if off-site, facilities, and an understandingof possible conflicts of interest for any physician who may have provided medical exams and/or medical opinions to any potentialbeneficiary of the Railroad Retirement Board. RRB will also evaluate the adequacy of medical personnel's credentials will beconsidered as will the qualifications and experience of key personnel and the amount of their time dedicated solely to this contract.Evaluation will be based on the physician/staff experience reviewing RRA and /Or SSA disability cases. RRB will also consider thephysician/staff experience reviewing insurance, workman's comp, and other 3 party disability cases.4. Quality Control PlanRRB evaluation will be based on the effectiveness of the offeror's plan to self-monitor the quality of its work and to aggressivelyidentify and correct deficiencies before they negatively impact operations and deliverables.5. Corporate Experience and Past Performance(a)RRB evaluation will judge the offeror's corporate experience and will include corporate reputation and experience in administeringcontracts of similar size, nature and complexity, and past performance of the offeror on similar contracts (the RRB will place greatervalue on the experience directly related to the requirement of this solicitation, including the review of Railroad Retirement DisabilityCases and Social Security Administration Disability Cases) which demonstrate the offeror's capability to meet the agency requirementsincluding:(1) The Contractor's overall implementation of the contract's requirements, including timeliness and the ability to meet establisheddeadlines,(2) The Contractor's effectiveness in business relations in interfacing with agency/organization personnel, including billing accuracy and resolving discrepancies, the ability to meet agency/organization security requirements, and the ability to cooperate with and respond to inquiries by agency/organization personnel in an effective manner.(3) The Contractor's quality of service, including overall technical competence and the accuracy of reports, and the effectiveness and reliability of key personnel and staff.(b) Information utilized will be obtained from the references listed in the proposal, other customers known to the Government, consumer protection organizations, and others who may have useful and relevant information. Information will also be considered regarding any significant subcontractors, and key personnel records.(c) Evaluation of past performance will often be quite subjective based on consideration of all relevant facts and circumstances. It will include a determination of the offeror's commitment to customer satisfaction and will include conclusions of informed judgement. However, the basis for conclusions of judgement will be documented.(d) Award may be made from the initial offers without discussions. However, if discussions are held, offerors will be given an opportunity to address unfavorable reports of past performance, if the offeror has not had a previous opportunity to review the rating. Recent contracts will be examined to ensure that corrective measures have been implemented. Prompt corrective action in isolated instancesmay not outweigh overall negative trends.(e) If an offeror, or the proposed employees for the offeror, do not have a past performance history relating to this solicitation, the offerorwill not be evaluated favorably or unfavorably on this factor.D. A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offers specifiedexpiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.Offerors should provide their best initial offer, as the government may award without discussions. However, this desire approach bythe government does not preclude the government from conducting discussions.Section VIIAttachments: See Attachments A and B.