Government Contract | Idaho
Medicaid Quality Improvement Organization Services

Bid Information

Bid Alert No: 00000500627

Bid Title: Medicaid Quality Improvement Organization Services

Agency Bid No. Title: RFP16000127

Received Date: 03/03/2016

Close Date: 04/06/2016

Purchase Type: Not Stated

Delivery Point:

Delivery Date: Not Stated

Special Notices: Other Optional 03/07/2016 03:00 PM: Registration, Pre-Bid Conference Optional 03/08/2016 11:00 AM, Questions Due By Optional 03/14/2016


Specifications include, but are not limited to:The Idaho Department of Health and Welfare is seeking proposals for Medicaid Quality Improvement Organization utilization review services-Scope of Work Section(s) I, XIII, XVII, and XIX are mandatory requirements and will be included in the resulting contract but do not require a response, except to affirmatively indicate offerors willing to comply with each mandatory requirement.I.General RequirementsA.The Contractor shall:1.Perform utilization and quality control review services for the Idaho Department of Health and Welfare (Department).2.Comply with all provisions of state and federal laws, rules, regulations, policies and guidelines as indicated, amended or modified that govern performance of the services.3.Meet all requirements for a Quality Improvement Organization (QIO) as specified in the United States Code of Federal Regulations, Title 42, Parts 475-480.4.Maintain accreditation from the Utilization Review Accreditation Commission (URAC) in both Health Utilization Management and Case Management. The Department will request proof of accreditation annually.5.Use nationally recognized evidence-based clinical criteria for medical necessity review, subject to approval by the Department.6.Attend an Implementation Meeting with the Department and the Contractors representatives, after the contract is executed, to review the contract requirements and timelines. Expenses related to attending this meeting are the responsibility of the Contractor.7.Notify the Department of any change in contract administration staff, medical staff, and clinical review staff. A statement of qualifications including resumes is required for all key employees who are working on the Idaho contract. Key employees are: Medical Director(s), Contract Administrator, Case Managers and Nurse Reviewers. The Department will review any changes in key employees. The Contractor shall:a.For anticipated changes, notify the Department ten (10) or more business days prior to the change, or as soon as possible.b.For unanticipated changes, notify the Department as soon as possible, but no later than two (2) business days after the Contractor becomes aware of the change.8.Provide training related to review requests and QIO processes to Department staff and Medicaid Providers as requested by the Department.9.Designate a Contract Administrator to be responsible for contract acceptance, amendments, and oversight.10.Designate a Contract Manager who will be the primary contact for the Department, and who will cooperate fully with respect to the direction and performance of the contract.11.Participate in conferences with the Department as stated below

Product Codes: 91869, 91878

Agency Information

Issuing Agency: State of Idaho - Department of Health and Welfare

State: Idaho

Agency Type: State and Local

Contact: Bev Berends Idaho Department of Health and Welfare, 450 W. State St., Boise, Idaho, 83702

Phone: 208-334-6635

Fax: 208-334-5694




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