Government Contract | Maryland

Bid Information

Bid Alert No: 00000509652


Agency Bid No. Title: 17-15992

Received Date: 03/14/2016

Close Date: 04/06/2016

Purchase Type: Not Stated

Delivery Point:

Delivery Date: Not Stated

Special Notices: Pre-Bid Conference 03/16/2016 02:00 PM


Specifications include, but are not limited to: The Contractor shall be responsible for performing the following activities for the duration of the Contract:3.2.1 External Quality Review Activities3.2.1.1 Systems Performance Review Assessment of Compliance with Medicaid Managed Care RegulationsA. The Contractor shall perform the Systems Performance Review (SPR; see Section 1.2.45) to assess eachHealthChoice MCOs compliance with federal and Maryland laws and regulations. This assessment includesdetermining the adequacy and effectiveness of the MCOs operational infrastructure and evaluating theQuality of services provided to Medicaid Participants (see Section 1.2.38 for definition of Quality). Prior to2016, the Department required this assessment annually. The SPR performed under this Contract shall be thefirst to occur on a three-year cycle.B. Unless otherwise specified by the CM, the SPR will be conducted in 2019 and review Calendar Years 2016,2017, and 2018. This SPR will be a comprehensive review of all standards.1. The Contractor shall conduct annual intermediate desktop or onsite follow-up reviews for MCOsreceiving partially met or unmet findings from the previous SPR to determine compliance with statedCorrective Action Plans (see Section 1.2.13).2. The Contractor shall conduct desktop reviews for baseline standards introduced during a year thatdoes not coincide with the comprehensive review year (2019), as applicable.3. The Contractor shall issue an assessment report, recommendations, and/or additional CorrectiveAction Plans resulting from intermediate or baseline reviews, as applicable.4. The Contractor shall offer technical assistance to MCOs to resolve deficiencies as needed.C. The Contractor shall develop a protocol and timeline for the SPR consistent with CMS EQR Protocol 1:Assessment of Compliance with Medicaid Managed Care Regulations and its attachments (Attachment P).1. The Contractor shall be responsible for ensuring its protocol remains compliant with any changes tothe CMS EQR Protocol and COMAR regulations.2. The protocol and timeline shall be subject to approval by the CM.D. The Contractor shall develop a timeline for initiation, performance, and completion of all SPR activities (i.e.,full and intermediate reviews). The timeline shall conclude with the issuance of the final audit reports to theMCOs and to the CM by May 31 of the Contract year or a timeframe otherwise specified by the CM. Thetimeline should account for the following activities:1. Obtaining CM approval for preliminary and final audit reports;2. Submitting preliminary reports to the MCOs for review and comment; and,3. Receiving Corrective Action Plans from the MCOs for analysis and inclusion into the final reports.E. The Contractor shall submit to the CM for approval any recommended updates or revisions to the SPR reviewcriteria annually from July 1 to August 31 of each Contract year, including the year of Contract transition. RFP Template Version: 10/27/2015321. The CM and the Contractor shall collaborate on any substantive updates to the SPR review criteria.2. The Contractor shall prepare a crosswalk of SPR review criteria to NCQA Accreditation standards(see Sections 1.2.30 and 1.2.1, respectively) to determine which SPR review criteria are eligible forDeeming (see Section 1.2.14), in accordance with when each MCO has received NCQA accreditation.3. The CM shall have final approval of all SPR review criteria and all deemed standards.4. The approved criteria shall be provided in an orientation manual that shall be distributed by theContractor to the MCOs at the annual September Quality Assurance Liaison Committee (QALC)meeting (see Sections 1.2.39 and 3.2.4.A.3).The current standards for the 2016 SPR are included inAttachment Q.F. Prior to the SPR onsite review, the Contractor shall obtain information from each MCO consisting of at leasta pre-site survey, and all applicable written plans, policies, and procedures for a desktop review. Deadlines forsubmitting information for the pre-site survey and conducting the desktop review shall be included in thetimeline in After the desktop review is complete, the Contractor shall schedule a two- to three-day onsite review witheach MCO at the administrative office of the MCOs choosing. The onsite review shall conclude with an exitinterview that provides the MCO with a significant review finding, probable areas of non-compliance, andpossible areas that can be clarified or corrected with the provision of additional information by the MCO.H. The Contractor shall send a letter identifying all areas of non-compliance or requests for additionalinformation within 10 Business Days (see Section 1.2.4) of the review, and permit the MCO 10 BusinessDays to respond to the letter. Each letter shall be reviewed and approved by the CM.I. The Contractor shall develop a preliminary report of findings for each MCO, with each report subject toapproval by the CM.1. After CM approval and preliminary report distribution, the Contractor shall extend the option to eachMCO to discuss the preliminary reports findings, in a time frame established by the Contractor andthe CM.2. The discussion may be held in person or by phone, at the MCOs option. In-person discussions shallbe held at 201 West Preston Street, Baltimore, MD 21201.3. The Contractor shall inform each MCO when Corrective Action Plans are due, if applicable, at theconclusion of the discussion.J. The Contractor shall collect, review, and evaluate all complete Corrective Action Plans within 10 BusinessDays of submission by the MCO. The Contractor shall include approved Corrective Action Plan informationin each MCOs final report.K. The Contractor shall include the following information in its final report for each MCO:1. Objective, technical methods of data collection and analysis, and data obtained for each Contractactivity;2. Conclusions drawn from the data, including assessment of MCO strengths and weaknesses withrespect to the timeliness, access, and quality of health care services furnished to recipients;3. Recommendations for improving compliance;4. Assessment of MCOs Corrective Action Plans submitted after receiving the draft report; and,5. Assessments of the implementation of the MCOs Corrective Action Plan from the previous SPR andany intermediate reviews.L. The Contractor shall maintain documentation of all aspects of the SPR and make this information available tothe CM.RFP Template Version: 10/27/2015331. The Contractors documentation shall be sufficiently detailed to allow the CM and/or subsequentContractors to understand the work performed, the evidence obtained, and how conclusions werereached.2. The Contractors documentation shall be well-organized, adequately cross-referenced between reportresults and supporting documentation, and sufficiently detailed to create a comprehensive andcomplete record of activities performed.M. The Contractor shall incorporate the results, findings, and recommendations of the SPR into the AnnualTechnical Report (ATR; see Sections 1.2.3 and 3.2.2). The report shall include trends across all MCOs andtrends specific to each MCO

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Product Codes: 91869, 91888, 91878

Agency Information

Issuing Agency: State of Maryland - Department of Health and Mental Hygiene

State: Maryland

Agency Type: State and Local

Contact: Theresa Ammons 201 W. Preston St., Room 416B, Baltimore, Maryland, 21201

Phone: 410-767-1361

Fax: 410-333-7141




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