SIMPLIFIED REQUEST FOR PROPOSALS
Agency of Human Services, Department for Children and Families
Title: Medical Consultant Services for Disability Determination
Date: December 3, 2014
Requisition Number: 0344015DDS0001
1 BACKGROUND AND SCOPE: The Vermont Department for Children and Families, Disability Determination Services, (hereinafter called DCF) is seeking to establish service agreements with one or more physicians who can provide Medical Consultant Services for Disability Determination Services located at 93 Pilgrim Park Road, Suite 6, Waterbury, VT 05676.
Required Qualifications
♦ Licensure – current, unrestricted Vermont licensure as doctor of medicine and osteopathy
♦ Board certification (or board eligible) in their specialty
♦ Availability – ability to provide consultative services approximately fifteen (15) hours per week at the Disability Determination Services office in Waterbury, VT. Since interaction between the consultant and the adjudicators is frequently required in the case assessment process, services must be performed between 6:00 AM and 6:00 PM Monday through Friday in the Waterbury office.
♦ Basic computer skills –required for such activities as
° Reading electronic files with administrative forms, application data, and medical evidence
° Completing electronic forms and typing narrative text to explain your assessment
° Navigating using Microsoft Windows and other Disability Determination specific software programs
° Researching internet medical texts and program policy resources
° Sending and reading email communications
♦ Prior to contract execution, selected candidates must pass any level of background investigation applicable to the position. AHS Policy 4.02, Hiring Standards, pursuant to 20 V.S.A. 2056c or other applicable statutory authority, requires criminal record checks for all AHS positions, including motor vehicle driving record checks and national record checks where appropriate.
Preferred Qualifications
Preferred disciplines include General Medicine, Internal Medicine, Family Practice, Primary Care, Neurology, Occupational Medicine, Ophthalmology, Osteopathy, Physiatry, Pulmonology, Cardiology, Pediatrics, and Psychiatry. Preferred candidates must have at least 3-5 years postdoctoral experience. Further preference will be given to experience working within an interdisciplinary team and to knowledge of the Social Security Disability program or other disability eligibility programs, although these are not required.
Introduction
The purpose of this Request for Proposal is to obtain the services of medical professionals in assessing the medical eligibility of Vermont applicants for Social Security Disability Insurance, Supplemental Security Income, and/or Medicaid on the basis of a disability. These consultant services include oral and written consultations concerning assessment of impairment severity and residual functional capacity based on reviews of disability case files and application of Social Security disability program policy. No patient contact is involved. Basic computer proficiency is necessary to read electronic case files, complete forms, type assessment narratives, and correspond via email with claim adjudicators. There is some required telephone contact with healthcare providers to clarify their reports and opinions. Medical consultants perform their work at the Disability Determination Services office, under the direction of DDS personnel. The hourly rate of compensation is according to the established fee schedule (below); In addition, the State of Vermont provides FICA employer contributions and performs wage withholding for tax and FICA purposes. The State of Vermont also carries general liability coverage for contractual Disability Determination medical consultants. For this position, the professional liability (malpractice) insurance requirement is waived, as the contract involves no patient-doctor relationship or direct patient care. Contractors are not eligible for any additional state benefits.
The selection will be made by 1) ranking candidates on qualifications and experience through review of the submitted documents and a panel interview; and 2) determining the number of contracts to award based on the number of hours per week that the top-ranking candidates offer.
A. PROGRAM BACKGROUND
The Vermont Office of Disability Determination Services determines the medical eligibility of Vermonters who apply for disability benefits under Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) and Medicaid on the basis of a disability. Under the Social Security Act, this office has statutory authority to make determinations of disability for the Social Security Administration’s disability programs and for Medicaid eligibility. Disability Determination Services must follow all federal statutes, rulings, regulations and policy related to these programs. Its work is subject to quality review by Social Security and must meet regulatory performance requirements. It is fully federally funded with a budget of approximately $5.9 million per year. It processes approximately 9800 disability claims and continuing disability reviews per year with a staff of 35 state employees and 15 medical/psychological consultants. The DDS mission is to provide applicants with accurate decisions as quickly as possible with full and fair consideration of each applicant’s situation and with respect and concern for the individual’s well-being and legal rights.
B. SERVICE DESCRIPTION
Medical consultative services are needed for case assessment, and recommendations on case documentation and assessment of the evidence regarding medical severity and residual functional capacity, following Social Security Disability Program regulations and policy.
These consultative services will assist the staff of the Disability Determination Services in Waterbury, VT in disability determinations and case processing. The cases are those of all Vermont disability applicants and beneficiaries whose continued eligibility is reviewed periodically. In partnership with the Social Security Administration, consultants may also be assigned cases from other states to assess, depending on national program needs and the Vermont DDS’s available capacity.
All work will be performed on a regular weekly schedule at the Disability Determination Services office in Waterbury, VT, as it requires secure access to the Social Security disability claims processing computer system and face-to-face interaction with adjudicators.
C. SERVICE GOALS & OUTCOMES:
Goals & Objectives:
· Provide accurate medical case assessments, promptly and efficiently completed, and other advisory case reviews that support accurate, timely, cost-effective disability determinations for all Vermont applicants and beneficiaries.
· Contribute to the overall quality of disability determination through case consultation, guidance, and training provided to Disability Determination staff on medical issues involved in documenting and adjudicating cases
Outcomes:
In order to assess the accuracy and efficiency of consultants’ assessments, the DDS will track case reviews with the following expectations:
· By the end of the first year, the consultant will review/assess cases and perform other case actions on average* within 90 minutes or less, while maintaining at least 96% assessment accuracy
· By the end of the second year, the consultant will review/assess cases and perform other case actions on average* within 75 minutes or less, while maintaining at least 98% assessment accuracy.
· By the beginning of the sixth year, the consultant will review/assess cases and perform other case actions on average* within 60 minutes or less, while maintaining at least 98% assessment accuracy.
* NOTE: Average case completion speed is measured. Completion times for individual cases will vary based on case size and complexity.
D. SPECIFICATIONS
· Review disability cases and provide accurate assessments of medical severity and residual functional capacity, based on case evidence
· Contact medical sources for further information and/or clarification of their reports
· Provide verbal consultation to adjudicators on case assessment and development issues
· Review and appropriately approve/sign adjudicator-completed case assessments
· Share medical specialty expertise and provide training on medical issues involved in documenting and adjudicating cases to Disability Determination staff, other medical/psychological consultants, and the medical community upon request
Mandatory Requirements, Standards & Targets:
· Maintain current, unrestricted Vermont licensure as a doctor of medicine or osteopathy with board certification/eligibility
· Pass the background investigation applicable to the position prior to contract execution. AHS Policy 4.02, Hiring Standards, pursuant to 20 V.S.A. 2056c or other applicable statutory authority, requires criminal record checks for all AHS positions, including motor vehicle driving record checks and national record checks where appropriate.
· Attend scheduled programmatic medical trainings and meetings, if requested
· Develop and maintain the computer skills necessary to
o Quickly and efficiently read electronic files with administrative forms, application data, and
medical evidence
o Quickly, efficiently, and accurately complete electronic forms and type narrative text to explain case assessments
o Research online medical and program policy resources
o Communicate quickly and efficiently via email
· Perform the service delivery activities listed above on a regular weekly schedule acceptable to the Disability Determination Services and modifiable with DDS approval. Interaction between the consultant and adjudicators is frequently required in the case assessment process; thus, services must generally be performed between 6:00 AM and 6:00 PM Monday through Friday in the Waterbury Disability Determination office.
· Perform the service delivery activities listed above with programmatic accuracy in the most cost-effective and efficient manner, under the direction of the State, meeting the following performance measures.
E. PERFORMANCE MEASURES:
Primary Outcome:
· Provide accurate, promptly and efficiently-completed medical case assessments, consults, reviews of adjudicator-completed assessments and related case actions
Performance Measures:
1. Accuracy - measured through internal quality review and external (Social Security) quality review samples of cases containing the consultants’ activities/outputs listed above
Two aspects
· Assessment accuracy is making the correct judgment as to impairment severity and level of limitation in the various functional areas. Assessment accuracy rate is the percent of accurate assessments out of all assessments that receive quality review.
· Narrative quality – Satisfactory narrative quality includes thorough, complete explanation, covering all allegations and impairments, citing pertinent findings that formed the basis of the assessment, addressing the credibility of statements concerning symptoms and functional limitations, and weighing medical source opinion statements in a manner consistent with Social Security regulations and policies.
Performance Criteria
· For a consultant with less than one year’s experience, program accuracy will develop with training and feedback. By the end of the first year, the consultant is expected to be released from 100% training review after achieving at least 96% assessment accuracy and satisfactory narrative quality.
· By the end of the second year, and thereafter, consultants are expected to regularly achieve an assessment accuracy rate of 98% or better with satisfactory narrative quality
2. Production/Speed – measured by the monthly “Weighted Minutes per Case” (WM/C) where
· A case review/assessment counts as 1 case
· A telephone contact counts as 1 case
· A verbal case consultation counts as a ½ case
· A review/sign-off of an adjudicator-completed medical assessment counts as a ½ case
· An update counts as a 1/3 case
The number of minutes the consultant works each month (from the daily time log sheets and electronic time reports the consultant submits) divided by the weighted count of completed case-related activities/outputs is the consultant’s WM/C.
Performance Criteria (These performance criteria are reasonable expectations based on current medical consultants’ performance at the DDS):
· For consultants with less than one year’s experience, production/speed will develop as they learn the disability program guidelines, the electronic folder organization and navigation techniques, and the method of electronic forms completion. By the end of the first year, the consultant is expected to achieve a WM/C of 90 minutes or less, while maintaining the accuracy expectations.
· By the end of the second year, the consultant is expected to achieve a WM/C of 75 minutes or less, while maintaining the accuracy expectations.
· By the beginning of the sixth year, the consultant is expected to achieve a WM/C of 60 minutes or less, while maintaining the accuracy expectations.
Notes:
· WM/C is an average. Some individual cases will take longer and others will take less time, depending on volume and complexity.
· If a consultant is assigned only to do very complex cases, the above productivity/speed standards will be adjusted according to the amount of time those cases actually require.
· If a consultant is assigned to provide a significant amount of general medical or programmatic training/mentoring, the above productivity/speed standards will be adjusted to take account of the work time spent on non-case specific activities/outputs.
F. PROGRAM ADMINISTRATION AND EVALUATION
New consultants receive training in Social Security Disability Program medical case assessment from the Chief Medical Consultant and senior adjudicative supervisors and staff, followed by case-by-case mentoring and quality review, until the consultant has demonstrated full understanding of the application of program policy in a broad range of individual case assessments. Consultants also receive training in the Social Security disability case processing system, navigation of the electronic case file, and use of the computer applications for selecting cases to review, doing the programmatic medical evaluation, documenting case assessments and other actions. Ongoing and refresher training is provided by the Disability Determination Services and/or the Social Security Administration.
Consultants submit daily time logs and biweekly electronic time reports. They receive payment through the State of Vermont payroll system following the payment provisions listed below.
Disability Determination Services performs quality reviews and maintains productivity/speed and accuracy performance data on each consultant. Each consultant receives performance feedback on a monthly, quarterly and annual basis. Failure to achieve the productivity/speed and accuracy standards for the length of disability program experience will result in a corrective action plan for a minimum of two months.
Hourly rates (below) are based on both length of experience and achievement of performance expectations. Delayed achievement of the standards for the next level will result in delay of the associated payment increase. Performance that falls below that expected of the current pay level, and does not return to the standard with the corrective action plan, will result in salary reduction to the level corresponding to the performance level and may result in cancellation of the contract (with 30 days advance notice).
Payment Provision
The maximum dollar amount payable under this agreement is not intended as any form of a guaranteed amount. The Contractor will be paid for products or services, as specified in the scope of work above, as needed by the Disability Determination Services’ workload and as actually performed by the consultant, up to the maximum allowable amount specified in the agreement.
Medical consultant contractors will receive compensation per hour of service according to the rates in the chart below along with achievement of the associated performance expectations (as explained above).