Request for Proposals for the Services of A

Note: It is beneficial to review your agreement with your Designated Medical Provided on a yearly basis. This model and your RFP can be used as a checklist and discussion starter for those annual reviews.

Request for Proposals for the services of a

Designated Healthcare Provider

Member’s Name, Iowa

The Member’s Name is seeking proposals from qualified physicians, clinics or practice groups (“firms”) for a Designated Healthcare Provider for the City/County/Agency/Etc. employees.

The successful firm will provide the following services to the Entity Type employees:

·  Pre-employment physicals/Functional Capacity Evaluation (FCE)

·  Pre-employment drug screens

·  Post-incident and random drug and alcohol screens

·  Physical abilities testing

·  Care for work-related injuries and illnesses

·  Audio testing

·  Pulmonary function testing

·  Medical screens

·  Physical therapy

Interested firms are invited to prepare a proposal that includes the following information.

1.  A letter of transmittal, including the name, title, and telephone number of the person who can best answer detailed questions about the firm’s proposal.

2.  An overview of the firm, including:

a.  A brief history of the firm,

b.  The size of the firm in terms of number of staff and number of patients,

c.  Professional affiliations or memberships, if any, and

d.  Contractual relationships or partnerships with other healthcare providers, if any.

3.  A list of 3-5 current clients for whom the firm is providing services similar to those listed above, including:

a.  The name and address of the client,

b.  The number of employees the client has, and

c.  The name, title, and telephone number of the client’s contact person who can best discuss the client’s experience with the firm.

4.  A list of the staff who would have service responsibility for Member’s Name in the event the firm was selected, including:

a.  The names and titles of the staff,

b.  Brief biographies of the staff, including the length of time each staff member has been with the firm, educational experience and degrees, professional accreditation or affiliations, occupational medicine experience.

5.  A description of the services that the firm provides, including, at a minimum:

a.  Pre-employment physicals/Functional Capacity Evaluation (FCE) (please attach a copy of the pre-employment physical exam form),

b.  Drug screen and breath alcohol screen (in compliance with the US Department of Transportation commercial driver regulations and including testing for marijuana, cocaine, amphetamines, opiates, and PCP),

c.  Physical abilities (push, pull, lift, etc.),

d.  Work injury care,

e.  Audio testing,

f.  Pulmonary function testing,

g.  Physical therapy,

h.  Job description/essential functions,

i.  Return-to-work evaluation/accommodation

j.  Any other value-added services.

6.  A description of customer service standards, including:

a.  Timeliness of appointments (including setting up appointments as well as patient wait times),

b.  Timeliness of results,

c.  Method of communicating results (phone, fax, email, etc.),

d.  Facility access and parking availability,

e.  Days and hours of operation,

f.  A description of quality assurance procedures in place to ensure the accuracy, reliability, and privacy of test results,

g.  A list of services that the firm would subcontract to another firm, and

h.  Billing procedures, including a sample or mock-up of a monthly bill.

7.  A table of costs for the requested services, including all set up costs, per unit costs, administrative fees, and other costs.

Please submit an original proposal and five unbound copies to:

Member’s Name and Address

Proposals must be received by Date and Time. Proposals received after the cut-off time will be returned without consideration.

The evaluation team will review the proposals after they are received. One or more firms may be invited to make a presentation to the evaluation team. Prior to making a final selection, the evaluation team will schedule a tour of the firm’s facility at a mutually convenient time.

The City/County/Agency/Etc. may reject any or all proposals, or waive irregularities therein, for any reason. All costs associated with preparing a proposal are the sole responsibility of the proposing firm and will not be reimbursed by the City/County/Agency/Etc.

Designate Healthcare Provider RFP| Rev: 12.2016 | Iowa Municipalities Workers’ Compensation Association | 3