A. Must be a member of TDI’s Approved Doctor List as a doctor defined in Texas Labor Code §401.011(17);

B. Must not have been censured by any relevant professional organization, any regulatory agency, or certifying authority, or subject to any regulatory action and must hold a current active unrestricted license to practice in the State of Texas with the appropriate education, training, license and/or certification to provide the professional services required by TDI;

C. Must have a demonstrated commitment to quality health care and objective diagnosis and treatment as indicated by TDI’s review of the Applicant’s experience in workers’ compensation and utilization review;

D. Must have had an active practice in the State of Texas for three years.

 

A. Doctors, who are specialists in areas that are major system cost drivers for workers’ compensation, including but not limited to spine surgery, chronic pain management, neurology, radiology and certain diagnostic fields.

B. Knowledge of evidence-based medicine.  Under Texas Labor Code §401.011(18-a), “evidence-based medicine” means the use of current best quality scientific and medical evidence formulated from credible scientific studies, including peer-reviewed medical literature and other current scientifically based texts, and treatment and practice guidelines in making decisions about the care of individual patients.

C. Demonstrated five (5) years experience in workers’ compensation or utilization review.

D. Five (5) years experience as a designated doctor, peer reviewer, licensing board reviewer or IRO reviewer.

3. Grounds for Disqualification of Applicants.

Any of the following that apply to the Applicants may result in disqualification of an Applicant to this RFQ:

A. Any conviction of or plea of guilty or nolo contendere to a felony or misdemeanor involving theft, larceny, violation of insurance law, or any other crime of moral turpitude;

B. Any civil lawsuit alleging malpractice, negligence, fraud, breach of fiduciary duty, bad faith, conversion, or any other similar action;

C. Any entry of a civil judgment, or imposition of administrative fines or penalties, against the Applicant or a business in which the Applicant individual was an owner or principal;

D. Any situation that would create any appearance of impropriety in the event that Applicant is accepted as an MQRP Member;

E. An actual or potential conflict of interest; and/or

F. An action by a licensing board or credentialing panel that can result in deletion from the TDI list of approved doctors.

4. Services.

Members of the MQRP are selected by and work under the general direction of the Medical Advisor.  MQRP members must be healthcare practitioners as defined by the Texas Workers’ Compensation Act (“Act”), Texas Labor Code Chapter 401.001, et seq.  MQRP members assist the Medical Advisor in performing the duties required under §§ 413.0511 and 413.0512 of the Act, which include the following activities:

A. Accepting assignments, as denoted in the Assignment for Review By Medical Quality Review Panel Member form (Attachment H), to provide quality of care assessments of health care services and decisions regarding health care services under the Act and TDI rules under the direction of the Medical Advisor.

B. Providing recommendations as to the appropriate action to make regarding doctors, other health care providers, insurance carriers, utilization review agents, and independent review organizations.  Based on clinical or case reviews, the Member shall provide recommendations to the Medical Advisor as to the appropriate action to take regarding the performance and participation of the following system participants to include but not be limited to:

1. Healthcare Providers – for utilization and quality of care within reasonable and necessary standards of healthcare;

2. Insurance Carriers – for the appropriateness of payments and approval of authorization requests for healthcare;

3. Impairment Rating Evaluators – for quality of evaluations; and

4. Independent Review Organizations – for quality and consistency of Medical Dispute Resolution decisions.

C. Preparing and submitting an MQRP narrative report for each clinical or case review to the Medical Advisor that must include but not be limited to:

1. Statement of case name and identifying Member number;

2. Statement affirming the reviewer has no conflict of interest in reviewing the case;

3. Complete review of History, Physical Examination and Laboratory findings of the case;

4. Answers to all questions posed to reviewer by TDI Medical Advisor and TDI staff;

5. Clinical rationale and support for opinions and decisions made; and

6. All worksheets and tables and other documentation produced in the review.

D. Completing and returning all assessments, reviews, and evaluations upon completion of assignments (see Attachment H). Assignments will be monitored by TDI as necessary.

E. Providing expert services to include:  consulting, testifying, depositions, and/or testimony through all levels of litigation regarding their findings, determinations, processes and procedures.

F. Serving on ad hoc work groups formed by the Medical Advisor to assist in the development of policies, procedures, guidelines and other processes necessary for the efficient operation of the MQRP and TDI.

G. Review and advise TDI on other miscellaneous special projects of interest to TDI.

5. Contract Period.
The term of any contract resulting from this RFQ shall be from the date the contract is fully executed and shall terminate on August 31, 2008 or unless otherwise terminated under the terms of Attachment F, Terms and Conditions of Contract, Section 15, which is incorporated in this RFQ by reference for all purposes.  TDI, in its sole discretion, has the option to renew the contract for two (2) additional one-year periods (September 1, 2008 through August 31, 2009 and September 1, 2009 through August 31, 2010).  Such renewal shall be subject to all specifications and terms and conditions of the original contract. 

 
6. Contract Payment.

A. Hourly Rates for Review of Claim Files.  Payment shall be made only for services rendered at the following hourly rates: 

1. Review by Doctors.  Payment for the preparation and submission of the MQRP narrative report by Members who  are doctors, as defined by §401.011(17) of the Act, shall be made at the hourly rate of $100.00.

2. Review by Non-doctors.  Payment for Members who are not doctors, as defined by the Act, shall be made at the hourly rate of $50.00.

3. Limits on Hours.  Member shall not be paid for more than 5 hours for his/her review of a single claim file or for more than 20 hours in any given calendar month unless the Medical Advisor approves in writing the additional hours upon review of the MQRP submitted narrative report.   

B. Ad Hoc Work Groups.  Members may be requested by the Medical Advisor to serve on ad hoc work groups.

1. Doctors.  Payment for serving in ad hoc work groups by Members who are doctors, as defined by the Act, shall be made at the hourly rate of $100.00.

2. Non-Doctors.  Payment for Members who are not doctors, as defined by the Act, shall be made at the hourly rate of $50.00. 

C. Hearing or Trial Preparation. 

1. Doctors. Payment for time spent in hearing or in trial preparation and/or in providing testimony in deposition, hearing or trial by Members who are doctors, as defined by the Act, shall be made at the hourly rate of $350.00.

2. Non-Doctors.  Payment for Members who are not doctors, as defined by the Act, shall be made at the hourly rate of $175.00.

3. Limits on Payment.  Member shall not be paid for more than 8 hours per day for his/her deposition, hearing or trial preparation and/or court testimony.  If travel is required in providing testimony, TDI will pay Member for travel, lodging and per diem expenses in accordance with the Texas State Travel Regulations.  This provision shall survive and be enforceable after termination of the Member’s Contract.

D. Members shall be paid upon approval of Medical Advisor. In accordance with the Texas Government Code Chapter 2251, TDI will make payment(s) on a properly prepared and submitted Assignment sheet (see Attachment H) within 30 days of receipt.  Assignment sheets are to be submitted to:  Texas Department of Insurance, Division of Workers’ Compensation, 7551 Metro Center Drive, ATTN: Medical Review MS-41, Austin, TX 78744-1609.

7. Evaluation.

All qualifying Responses received by the deadline above will be evaluated based on qualifications, experience, and agreement to the sample contract.  TDI will make the final selections in accordance with Chapter 2254, Subchapter A, Texas Government Code in its sole discretion in the best interests of TDI and the State of Texas.

The Commissioner of Workers’ Compensation, TDI, Division of Workers’ Compensation will appoint an evaluation committee of knowledgeable TDI employees to evaluate RFQ responses and make recommendations for qualification.  The evaluation committee will review the responses to determine if they have been properly completed.  Provided that a response is properly completed, the evaluation committee will review the content of response, and determine if the Applicant meets the requirements described in this RFQ. The evaluation committee may consider the following:

A. Experience and abilities of Applicant

B. Reference or background checks of Applicant

The evaluation committee presents the recommended applicants to the Commissioner of Workers’ Compensation for review and determination by the Commissioner of Workers’ Compensation or his designee.

8. Rejection of Responses.

TDI reserves the right to reject, in its sole discretion, any or all RFQ responses and all or any part of any response and waive minor technicalities.  TDI's waiver of any deviations in any response will not constitute a modification of this RFQ and will not preclude TDI from asserting all rights against Applicant for failure to fully comply with all terms and conditions of this RFQ.

9. Notification to Applicants.

All applicants who have submitted complete responses will be notified in writing of TDI’s decision regarding the acceptance or rejection of an application.  TDI’s decision to reject a response is final, and applicants will not have the opportunity to re-apply unless and until TDI issues a subsequent Request for Qualifications for MQRP Members.

10. Limitations.

TDI reserves the right to accept or reject any or all Responses submitted in response to this RFQ.  TDI is not obligated to execute any contract or contracts or any specific number of contracts as a result of issuing this RFQ.  TDI further reserves the right to issue additional RFQs or other solicitations for the contracted or similar services at any time as TDI determines are necessary to ensure an adequate number of Members for any assigned reviews under this process.

11. No TDI Obligations for Costs.

TDI accepts no obligations for costs incurred in responding to this RFQ in anticipation of being awarded a contract.  All of the costs and expenses incurred by any Applicant in connection with or arising out of its possible or actual Response to this RFQ shall be entirely the responsibility of the Applicant and shall not be borne or reimbursed directly or indirectly by TDI.

12. Obligations of Selected Applicant.

Any Applicant selected as a Member will be responsible for the performance of any contractual obligations that may result from an award based on this RFQ.  By submitting a Response, acknowledging and accepting the contract, or delivering any services under the contract, Applicant acknowledges, accepts and agrees to all terms of the contract, including, but not limited to, this RFQ.  A Response to this RFQ is an offer to contract with TDI based upon the terms, conditions and specifications contained in this RFQ. 

13. No Obligation by TDI.

Issuance of this RFQ does not constitute a commitment on the part of TDI to award a contract. TDI is under no obligation to award any contract as a result of this RFQ.  TDI maintains the right to reject any or all proposals/applications and to cancel this RFQ if it considers it in the best interests of TDI to do so.  Under this RFQ, TDI reserves the right to select and contract with one or more Applicant to serve on the MQRP on an as-needed basis.  No minimum amount of assignments or compensation is guaranteed to any selected Applicant.

14. Right to Amend, Modify, or Withdraw the RFQ.

TDI reserves the right to alter, amend or modify any provisions of this RFQ or to rescind, revoke, or withdraw this RFQ, in whole or in part, at any time prior to the award of any contract if it is determined by TDI to be in the best interest of TDI or the State to do so.

15. Public Information.

TDI is subject to the Texas Public Information Act (Tex. Gov’t Code Ch. 552).  Respondent understands that TDI is bound by the provisions of the Texas Public Information Act and Attorney General Opinions issued under that statute.  Proposals submitted to TDI in response to this ITN become the property of TDI, may be reproduced by TDI and may be subject to release by TDI to any requestor as public information.  Any information that Respondent believes may be protected from disclosure should be clearly designated as such; such information may or may not be exempt from disclosure.

16. Protest Procedure.

Any protest shall be governed by TDI’s bid protest rules, which are set forth in 28 Tex. Admin. Code §§1.1101 – 1.1107.

B. Other relevant provisions of the Texas Labor Code regarding MQRP are as follows:

1. Tex. Labor Code §401.011(17) defines a “doctor.”

2. Tex. Labor Code §408.023 addresses the list of Approved Doctors.

3. Tex. Labor Code §408.0231 addresses the maintenance of the list of Approved Doctors, as well as sanctions and privileges.

4. Tex. Labor Code §413.0511(d) addresses immunity for a person who serves on the medical review panel.

18. Issuance of RFQs.

Submitting a response to this RFQ does not generate any rights or privileges with respect to any subsequent professional services contract. 

19. Release of Responses.

All responses to this RFQ become the property of TDI and may be subject to release to any requester under the provisions of the Texas Public Information Act, Chapter 552 of the Texas Government Code, and Attorney General Opinions issued under that statute. Further, all Applicants must authorize the release to the Commissioner of any and all records or information relevant to the matters disclosed in this Application.  Additional information or documentation may be requested by the Commissioner of Workers’ Compensation, and a failure to provide such information or documentation may result in the rejection of a response.

20. Waivers and Releases.
TDI does not waive any privileges, rights, defenses, remedies, or immunities available to it as an agency of the state of Texas, or any other rights available to TDI.  By submitting an Application, Applicant releases the Commissioner of Insurance, the Commissioner of Workers’ Compensation, TDI, and its employees and agents from any and all liability, claims, and lawsuits with respect to the information submitted by Applicant or obtained by TDI in connection with this Application.