VDOL WC Medical Fee Schedule

Agency:	State of Vermont
State:	Vermont
Type of Government:	State & Local
Category:	65 - Medical, Dental, and Veterinary Equipment and Supplies
Posted:	Mar 18, 2024
Due:	Apr 12, 2024
Publication URL:	To access bid details, please log in.

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Vermont Department of Labor

133 State Street, 5th Floor | Montpelier VT 05633-8000

802-828-2211 phone |802-828-2222 fax

http://bgs.vermont.gov/purchasing

SEALED BID

REQUEST FOR PROPOSAL

Workers’ Compensation Medical Fee Schedule

ISSUE DATE

QUESTIONS DUE

RFP RESPONSES DUE BY

March 18, 2024

March 29, 2024 - 4:30 (EST)

April 12, 2024 – 4:30 PM (EST)

PLEASE BE ADVISED THAT ALL NOTIFICATIONS, RELEASES, AND ADDENDUMS ASSOCIATED

WITH THIS RFP WILL BE POSTED AT:

http://www.bgs.state.vt.us/pca/bids/bids.php

THE STATE WILL MAKE NO ATTEMPT TO CONTACT INTERESTED PARTIES WITH UPDATED

INFORMATION. IT IS THE RESPONSIBILITY OF EACH BIDDER TO PERIODICALLY CHECK THE

ABOVE WEBPAGE FOR ANY AND ALL NOTIFICATIONS, RELEASES AND ADDENDUMS

ASSOCIATED WITH THIS RFP.

STATE CONTACT:

TELEPHONE:

E-MAIL:

Dirk Anderson, Director of Workers’ Compensation

(802)595-5436

dirk.anderson@vermont.gov

1. OVERVIEW:

1.1. SCOPE AND BACKGROUND: The Vermont Department of Labor is seeking to establish a contract with

a vendor that can provide a medical fee schedule to establish reimbursement rates for health care

providers who provide services covered by a workers’ compensation insurance policy, and to update the

fee schedule annually for an additional four years.

1.2. CONTRACT PERIOD: Contracts arising from this RFP will be for a period of five years with an option to

renew for up to two additional twelve-month periods. The State anticipates the start date for such

contract(s) will be May 1, 2024.

1.3. SINGLE POINT OF CONTACT: All communications concerning this RFP are to be addressed in writing

to the State Contact listed on the front page of this RFP. Actual or attempted contact with any other

individual from the State concerning this RFP is strictly prohibited and may result in disqualification.

1.4. BIDDERS’ CONFERENCE: A bidders’ conference will not be held.

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1.5. QUESTION AND ANSWER PERIOD: Any bidder requiring clarification of any section of this RFP or

wishing to comment on any requirement of the RFP must submit specific questions in writing no later than

the deadline for questions indicated on the first page of this RFP. Questions may be e-mailed to the point

of contact on the front page of this RFP. Questions or comments not raised in writing on or before the last

day of the question period are thereafter waived. At the close of the question period a copy of all

questions or comments and the State's responses will be posted on the State’s webpage,

http://www.bgs.state.vt.us/pca/bids/bids.php . Every effort will be made to post this information as soon as

possible after the question period ends, contingent on the number and complexity of the questions.

1.6. CHANGES TO THIS RFP: Any modifications to this RFP will be made in writing by the State through the

issuance of an Addendum to this RFP and posted online at http://www.bgs.state.vt.us/pca/bids/bids.php .

Modifications from any other source are not to be considered.

2. DETAILED REQUIREMENTS/DESIRED OUTCOMES:

2.1. The State of Vermont is interested in obtaining bids to meet the following business needs: The

establishment and annual amendment, for an additional four years, of two workers’ compensation medical

fee schedules: one for hospitals and ambulatory surgical centers, and one for medical practitioners.

2.2. See Attachment A: Statement of Work for more details.

2.3. Vendor Qualification Requirements :

The Vendor MUST:

1. Possess a thorough understanding of American Medical Association (AMA) CPT®, HCPCS, ICD-9-CM

and ICD-10-CM codes; IPPS, OPPS, and PPS payment systems;

2. At no cost to the Department, possess and maintain for the duration of the contract period, the required

AMA CPT® license from the American Medical Association, valid for the duration of this contract, including

but not limited to:

a. Vendor shall obtain or hold any and all licenses and authorizations from the AMA for the

inclusion of AMA CPT® codes and descriptions, including abbreviated descriptions, in the Fee Schedule

and for the right of Vendor to reproduce, publish and distribute; and having AMA CPT® codes and

descriptions (including any and all royalty fees and other payments);

b. Vendor shall obtain any renewals and extensions of said licenses and/or authorizations from the

AMA as may be necessary for the term of this contract; and

c. Royalty payments shall be a matter solely between Vendor and the AMA; the State of Vermont

and the Department of Labor shall be held harmless for any issues regarding payment or lack thereof.

6. Possess the required permission from the American Society of Anesthesiologists, Inc. to use ASA base

value units and concomitant licensing with the American Medical Association for AMA CPT® codes related

thereto, valid for the duration of this contract;

7. Possess the required knowledge and experience necessary to develop methodology to produce medical

fees and billing guidelines consistent with 21 V.S.A. §640(d);

8. Possess the required knowledge and experience necessary to develop methodology to produce hospital

and ambulatory surgical center fees and billing guidelines consistent with 21 V.S.A. §640(d);

9. Possess understanding and expert knowledge of laws and regulations of the State of Vermont

pertaining to medical, physician/medical provider, hospital, and ambulatory surgical center fee

assessments;

10. Possess understanding and expert knowledge of federal laws and regulations pertaining to medical,

physician/medical provider, hospital, and ambulatory surgical center fee assessments;

11. Possess expert knowledge and experience in workers’ compensation medical, hospital and ambulatory

surgical center billing codes and practices;

12. Possess expert knowledge and experience in Medicare billing practices with specific expertise in

Medicare fee schedule and coding systems utilizing RBRVS methodology; and IPPS, OPPS, and PPS

methodologies;

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13. Possess prior experience in developing medical fee schedules in which RBRVS methodologies; and

IPPS, OPPS, and PPS methodologies are employed;

14. Possess knowledge and resources to develop relative values and conversion factors for services

where there are no established Medicare RBRVS methodologies;

15. Possess prior experience in formulating and producing annual revisions to Fee Schedules for medical

practitioners and hospitals and ambulatory surgical centers who treat injured workers;

16. Possess expert knowledge and comprehension of Vermont’s Workers’ Compensation laws and

regulations;

17. Possess expert knowledge, understanding, and experience necessary to draft a “User’s Manual” for

use by hospitals, medical practitioners, and bill reviewers; said manual to be written in clear, concise, and

comprehensible language and with step-by-step instructions for coding, submitting, analyzing, repricing,

and/or paying bills in accordance with the applicable fee schedule.

18. Possess financial stability; and

19. Employ adequate personnel to develop the Annual Updates to the “Vermont Workers’ Compensation

Fee Schedule for Hospitals and Ambulatory Surgical Centers” and the “Vermont Workers’ Compensation

Medical Practitioner Fee Schedule” and demonstrate to the Department’s satisfaction existence of same.

3. GENERAL REQUIREMENTS:

3.1. PRICING: Bidders must price the terms of this solicitation at their best pricing. Any and all costs that

Bidder wishes the State to consider must be submitted for consideration. If applicable, all equipment

pricing is to include F.O.B. delivery to the ordering facility. No request for extra delivery cost will be

honored. All equipment shall be delivered assembled, serviced, and ready for immediate use, unless

otherwise requested by the State.

3.1.1.Prices and/or rates shall remain firm for the initial term of the contract. The pricing policy submitted by

Bidder must (i) be clearly structured, accountable, and auditable and (ii) cover the full spectrum of

materials and/or services required.

3.1.2.Cooperative Agreements. Bidders that have been awarded similar contracts through a competitive

bidding process with another state and/or cooperative are welcome to submit the pricing in response

to this solicitation.

3.1.3.Retainage. In the discretion of the State, a contract resulting from this RFP may provide that the

State withhold a percentage of the total amount payable for some or all deliverables, such retainage

to be payable upon satisfactory completion and State acceptance in accordance with the terms and

conditions of the contract.

3.2. STATEMENT OF RIGHTS: The State shall have the authority to evaluate Responses and select the

Bidder(s) as may be determined to be in the best interest of the State and consistent with the goals and

performance requirements outlined in this RFP. The State of Vermont reserves the right to obtain

clarification or additional information necessary to properly evaluate a proposal. Failure of bidder to

respond to a request for additional information or clarification could result in rejection of that bidder's

proposal. To secure a project that is deemed to be in the best interest of the State, the State reserves the

right to accept or reject any and all bids, in whole or in part, with or without cause, and to waive

technicalities in submissions. The State also reserves the right to make purchases outside of the awarded

contracts where it is deemed in the best interest of the State.

3.2.1.Best and Final Offer (BAFO). At any time after submission of Responses and prior to the final

selection of Bidder(s) for Contract negotiation or execution, the State may invite Bidder(s) to provide a

BAFO. The state reserves the right to request BAFOs from only those Bidders that meet the minimum

qualification requirements and/or have not been eliminated from consideration during the evaluation

process.

3.2.2.Presentation. An in-person or webinar presentation by the Bidder may be required by the State if it

will help the State’s evaluation process. The State will factor information presented during

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presentations into the evaluation. Bidders will be responsible for all costs associated with providing

the presentation.

3.3. WORKER CLASSIFICATION COMPLIANCE REQUIREMENTS: In accordance with Section 32 of The

Vermont Recovery and Reinvestment Act of 2009 (Act No. 54), Bidders must comply with the following

provisions and requirements.

3.3.1.Self Reporting: For bid amounts exceeding $250,000.00, Bidder shall complete the appropriate

section in the attached Certificate of Compliance for purposes of self-reporting information relating to

past violations, convictions, suspensions, and any other information related to past performance

relative to coding and classification of workers. The State is requiring information on any violations

that occurred in the previous 12 months.

3.3.2.Subcontractor Reporting: For bid amounts exceeding $250,000.00, Bidders are hereby notified that

upon award of contract, and prior to contract execution, the State shall be provided with a list of all

proposed subcontractors and subcontractors’ subcontractors, together with the identity of those

subcontractors’ workers’ compensation insurance providers, and additional required or requested

information, as applicable, in accordance with Section 32 of The Vermont Recovery and

Reinvestment Act of 2009 (Act No. 54). This requirement does not apply to subcontractors providing

supplies only and no labor to the overall contract or project. This list MUST be updated and provided

to the State as additional subcontractors are hired. A sample form is available online at

http://bgs.vermont.gov/purchasing-contracting/forms. The subcontractor reporting form is not

required to be submitted with the bid response.

3.4. EXECUTIVE ORDER 05-16: CLIMATE CHANGE CONSIDERATIONS IN STATE PROCUREMENTS:

For bid amounts exceeding $25,000.00 Bidders are requested to complete the Climate Change

Considerations in State Procurements Certification, which is included in the Certificate of Compliance for

this RFP.

After consideration of all relevant factors, a bidder that demonstrates business practices that promote

clean energy and address climate change as identified in the Certification, shall be given favorable

consideration in the competitive bidding process. Such favorable consideration shall be consistent with

and not supersede any preference given to resident bidders of the State and/or products raised or

manufactured in the State, as explained in the Method of Award section. But, such favorable

consideration shall not be employed if prohibited by law or other relevant authority or agreement.

3.5. METHOD OF AWARD: Awards will be made in the best interest of the State. The State may award one

or more contracts and reserves the right to make additional awards to other compliant bidders at any time

if such award is deemed to be in the best interest of the State. All other considerations being equal,

preference will be given first to resident bidders of the state and/or to products raised or manufactured in

the state, and then to bidders who have practices that promote clean energy and address climate change,

as identified in the applicable Certificate of Compliance.

3.5.1.Evaluation Criteria: Consideration shall be given to the Bidder’s project approach and methodology,

qualifications and experience, ability to provide the services within the defined timeline, cost, and/or

success in completing similar projects, as applicable, and to the extent specified below.

3.5.2.Criteria: The following table outlines the scoring criteria for bids.

Scoring Criteria

Proposed approach (thoughtful, comprehensive, clearly structured, easy to

understand)

Experience (demonstrated experience creating similar medical fee schedules,

ideally in rural states)

Price (reasonable, clearly structured, detailed, accountable, comprehensive)

Response includes the required content and format (see Section 4.)

Weighted Point %

35%

30%

25%

10%

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3.6. CONTRACT NEGOTIATION: Upon completion of the evaluation process, the State may select one or

more bidders with which to negotiate a contract, based on the evaluation findings and other criteria

deemed relevant for ensuring that the decision made is in the best interest of the State. In the event the

State is not successful in negotiating a contract with a selected bidder, the State reserves the option of

negotiating with another bidder, or to end the proposal process entirely.

3.7. COST OF PREPARATION: Bidder shall be solely responsible for all expenses incurred in the preparation

of a response to this RFP and shall be responsible for all expenses associated with any presentations or

demonstrations associated with this request and/or any proposals made.

3.8. CONTRACT TERMS: The selected bidder(s) will be expected to sign a contract with the State, including

the Standard Contract Form and Attachment C as attached to this RFP for reference. If IT Attachment D is

included in this RFP, terms may be modified based upon the solution proposed by the Bidder, subject to

approval by the Agency of Digital Services.

3.8.1.Business Registration. To be awarded a contract by the State of Vermont a bidder (except an

individual doing business in his/her own name) must be registered with the Vermont Secretary of

State’s office https://sos.vermont.gov/corporations/registration/ and must obtain a Contractor’s

Business Account Number issued by the Vermont Department of Taxes http://tax.vermont.gov/ .

3.8.2.The contract will obligate the bidder to provide the services and/or products identified in its bid, at the

prices listed.

3.8.3.Payment Terms. Percentage discounts may be offered for prompt payments of invoices; however,

such discounts must be in effect for a period of 30 days or more in order to be considered in making

awards.

3.8.4.Quality. If applicable, all products provided under a contract with the State will be new and unused,

unless otherwise stated. Factory seconds or remanufactured products will not be accepted unless

specifically requested by the purchasing agency. All products provided by the contractor must meet

all federal, state, and local standards for quality and safety requirements. Products not meeting these

standards will be deemed unacceptable and returned to the contractor for credit at no charge to the

State.

4. CONTENT AND FORMAT OF RESPONSES: The content and format requirements listed below are the

minimum requirements for State evaluation. These requirements are not intended to limit the content of a

Bidder’s proposal. Bidders may include additional information or offer alternative solutions for the State’s

consideration. However, the State discourages overly lengthy and costly proposals, and Bidders are advised to

include only such information in their response as may be relevant to the requirements of this RFP.

4.1. The bid should include a Cover Letter and Technical Response and Price Schedule.

4.2. COVER LETTER:

4.2.1.Confidentiality. To the extent your bid contains information you consider to be proprietary and

confidential, you must comply with the following requirements concerning the contents of your cover

letter and the submission of a redacted copy of your bid (or affected portions thereof).

4.2.2.All responses to this RFP will become part of the contract file and will become a matter of public

record under the State’s Public Records Act, 1 V.S.A. § 315 et seq. (the “Public Records Act”). If your

response must include material that you consider to be proprietary and confidential under the Public

Records Act, your cover letter must clearly identify each page or section of your response that you

consider proprietary and confidential. Your cover letter must also include a written explanation for

each marked section explaining why such material should be considered exempt from public

disclosure in the event of a public records request, pursuant to 1 V.S.A. § 317(c), including the

prospective harm to the competitive position of the bidder if the identified material were to be

released. Additionally, you must include a redacted copy of your response for portions that are

considered proprietary and confidential. Redactions must be limited so that the reviewer may

understand the nature of the information being withheld. It is typically inappropriate to redact entire

pages, or to redact the titles/captions of tables and figures. Under no circumstances may your entire

response be marked confidential, and the State reserves the right to disqualify responses so marked.

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TITLE	QUESTIONS DUE	ANSWERS POSTED	DUE DATE	NO POSTING AFTER
VDOL WC Medical Fee Schedule	03/29/2024 04:30PM		04/12/2024 04:30PM

VDOL WC Medical Fee Schedule

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