State of Maine Waiver of Competitive Bidding Request Form Form Instructions: Please provide the requested information in the white boxes below. This form is to precede contract requests that are not the direct resuit of a competitive bici process. Shawn Belanger 5,622,974.00 CT 10 A 20180125000000002251 0FI-18-200 6/30/2020 6/ 1/ 2018 Disability Evaluation Services Commonwealth Medicine University of Massachusetts Medical Schooi Shrewsbury, MA 99.0.58 . PmViSion 0f Disability Datermma?ons i" ACCOFdance With Medicaid Regulations - 1. Statutory Justification - State of Maine statute (5 aiiows_'wa_iyers of below. Piease mark the apprOpriate' box (X) .IieXtto the justification Which-applies precurement crowds for. . - "7124;1inrolves the expenditure of $2.500. Directorief the.Bureau..ot<3eneral .Seryicesjis?j make. purchases-witheuteem petitiV-e bidding. deSigneey'an emergency exists that requires the If citing the above By sr'gnmg below, I sigan as the Governor?s desr?gnee there is an emergency for thfs'Wafyerof Competitive that necessitates this non-competitive procurement. reeves; please ha ire the. Signature: ?requesting Departments . .- Commissioner or Chief Executive (as the. Governors 'Tidesrynee?? .1. sign and date arr-the. right. 5? C- r'After ?reasoriablejinvestisatien. lay-the .?se We?d enit or item ref-supply; or brand ,of that unit 0- 1t eppeats to be in. the 'besti?teiest 0f the State .to' E. purchase. is part eta. cooperative I MaineCommunitv institution of higher education with a main. campus lei-thisStatefiWQIVing? (1) An activity assisting a state agency andeahancing' System, Maine Maritime Academy; Ore Privaternoeprefit; Printed Name: Date: ionall - 7. .. 'eduCationwith a. main e. .mpus In this ?d A'sharing of project and, If Citrhg :theaboye justr?bation iforrhasa/ee} re ewe. - O??ree feeccordeece we: Execute/reader 1.1/1. The approve! mast be documented [The procurement of goods or Sawices'finVOiVeS. IDireCtOi-?ld the Bureau of Generai Services may accept oral G. The procurement of goods or services invoives expenditureSOf $10,000 procurEmEntfime source is the most economical, effective and appropriate means a demenstrateci need. '5 BP37WCB Page 1 of4 Rev. 7/ 13/2015 State of Maine Waiver of Competitive Bidding Request Form zr'a .diffe,ent_ '5 2-. Description of Specific Need Please identify, and fully describe, the .specifiCpi'obiem, requirement, .needthe. resulting {non-,jCompetitive contract -. would address and which makes the goods necessary. ._"Explain how_the__'reques_tin_g_ that the goods or services are critical and/or essential to agency responsibilities "0r operations. The Department is required to make determinations of disability for persons who are applying for Medicaid coverage in Maine due to a disability. The determinations must be made in accordance with 881 standards established by the Social Security Administration. These tasks are currently performed by a unit within the Department of Health and Human Services, Office for Family Independence known as the Medical Review Team (MRT). In accordance with the State biennial budget for 2018-2019, all of the positions within the MRT have been slated for elimination as of July 1, 2018. Disability determinations will still need to be performed after the elimination of the current MRT staff on June 30, 2018, it will be necessary to have this very specialized work performed by a contractor. 3. Availability of other Public Resources - - - - 1 -- .. 1. Please explain how the requesting Department concluded that suf?cient staffing, resources, 0r expertise is not available within the State of Maine?s government, or other governmental or federalagerlcies) external . to the requesting Department, which would be ableto. ._a_dd_ress the identifiedneed. and. effectivelythan The task of performing disability determinations is very specialized work. The Department, and any other governmental entity do not have the staff, resources and expertise to perform these services. 4. Cost -. -. . - - Since a waiver of competitive bidding isbeing requested for this procurement, Department concluded the negotiated costs,__fees, 0r rates are fair and reasdnabie. A comparison of the costs currently incurred by the Department for the provision of tasks associated with the disability determination process to the costs proposed by the Contractor for the provision of similar services was conducted. Although the overall proposed cost of the services to be provided by the contractor were higher than the current cost to the Department, the Department is confident that this slight increase in cost is more than balanced by the high quality of work to be performed. 5? Futurecompetition . . .. . . Please describe pote ntial opportunities may, be available. to fostercom petition for-these goods or . services in the future. The magnitude and complexity of the tasks involved with making a disability determination, the Department of Health and Human Services proposes the initial contact be for a period of two years with two one?year extensions. This will provide consistency during the four?year period that will be beneficial to the citizens of the State of Maine served by the contractor. Simultaneously, the Department will draft and issue a request for proposals for the provision of disability determination services. It is anticipated that the contract issued as a result competitive bidding will begin when the initial four?year contract expires. BP37WCB Page 2 of 4 Rev. 7/13/2016 State of Maine Waiver of Competitive Bidding Request Form 6. Uniqueness . - Please explain if the goods or services required are unique to a specific vendor. Describe the unique qualifications, abilities, and/or expertise of the vendor and how those particular unique factors address the specific need identified - above. If the vendor has unique equipment, facilities, ,or proprietary data, aisoexplain the necessity'ofthese The following list contains the unique quali?cations, abilities and expertise that UMASS provides relative to the specific needs of the Department as described in the response to Question 2 above. UMASS currently has 25 physician advisors on staff who are medical doctors of various specialties, including but not limited to internal medicine, nephrology, pediatrics and infectious diseases. These doctors will review medical records to make decisions. The MRT currently has a very small number of doctors who do not have the same breadth of knowledge reviewing medical records. - UMASS medical school monitors federal regulations and SSA Policy Operations Manual Systems (POMS) for changes in SSA disability regulations and provides subsequent training to their consultant staff. UMASS medical school has an established training program for all new consultant staff and ongoing training for existing consultant staff. 0 The skill level of UMASS medical school staff increases the likelihood that those recipients who have sufficient medical improvement will be identified and closed upon review. - UMASS medical school staff who make disability decisions are ?skilled professional medical personnel? who qualify for enhanced federal match. Only credentialed staff who work for a public agency are eligible for enhanced matching. UMASS medical school has credentialed staff to do the required vocational assessment (one of the determination steps). - The MRT currently pay less than $47 for a consultative exam and just over 200 exams were performed in the last fiscal year. This results in denials for lack of or insufficient medical information. This increases the number of reapplications, reconsiderations and/or administrative hearings. The Department proposes to adopt the UMASS medical school?s current rate structure for consultative exams. Although the rate is substantially higher, the Department believes the higher rate will result in the receipt of more medical information related to the disabling condition. This will result in correct decisions the first time that can be justified if challenged. The MRT is not currently performing consultative exams because doctors with this specialty will not accept the Department?s compensation rates. Many disabling conditions have a component. Through a contract with UMASS medical school, the Department intends to adopt their higher rate structure which should result in obtaining medical information. This will enable us to incorporate exams where appropriate and gather the necessary information to make correct decisions. UMASS medical school will provide trained, experienced staff to represent Maine in administrative hearings. We believe they will be more successful than our current staff in communicating how decisions were arrived at in regard to the 5 steps detailed in the federal regulations. This will increase the Department?s success with administrative hearings. - UMASS will be able to perform disability determinations within the mandated 45-day consent order for decision making. Timeframe (Complete only if B. is the Statutory Justification marked on Page 1) Please explain if time is of the essence and an emergency exists which requires the immediate procurement of goods or services. Describe the nature of this emergency, provide the date by which the goods or services must be delivered, explain how that date was determined and its significance impact if delayed beyond this date). Also, provide Eilnformation as to how it was determined this vendor is the best optionwto address this time?sensitive procurement. Page of 4 Rev. 7/13/2016 State of Maine Waiver of Competitive Bidding Request Form Signaturem= requesting . Departmen' their? - {1 Com missidnerts Office): a, By Signing below, I 5!ng that my Department requests, and I approve or: this Competitive Biddmg. Printed. - BP37WCB Page 4 of 4 Rev. 7/13/2016