Opportunity Detail

Questions and Answers

Hospital Utilization Management Program
Document #:  JFSR1213118003


Question:   Regarding page 22, 4.3.E., Acknowledging that specific study topics will be assigned to the vendor, may the vendor propose health care study topics in its proposal?

Answer:   See Inquiry 21877

Date: 3/21/2011

Inquiry: 21881


Question:   Regarding page 21, 4.3.C.7, To our knowledge, CMS is not currently requiring use of a specific set of Quality Screens. What Quality Screens are being referred to here?

Answer:   See Inquiry 21877

Date: 3/21/2011

Inquiry: 21880


Question:   Page 21, 4.3.C.7-to our knowledge, CMS is not currently requiring use of a specific set of Quality Screens. What Quality Screens are being referred to here? On page 22, 4.3.E-acknowledging that specific study topics will be assigned to the vendor, may the vendor propose health care topics in the proposal?

Answer:   The Department utilizes a previous version of the Medicare Quality Screens for the inpatient hospital reviews. The vendor may propose health care study topics, however, the Department has final discretion as to which studies are completed.

Date: 3/21/2011

Inquiry: 21877


Question:   Attachment D – Cost Proposal Form: Are per-review prices inclusive of reconsiderations, appeals, and hearings?

Answer:   Yes. The review prices are inclusive of reconsideration, appeals and hearings.

Date: 3/21/2011

Inquiry: 21897


Question:   Attachment D – Cost Proposal Form and Section 4.3.A, Focused Reviews: Would the Department consider a separate hourly rate for bill audits under focused review?

Answer:   No, the Department will not accept a different hourly rate for bill audits.

Date: 3/21/2011

Inquiry: 21898


Question:   Attachment D – Cost Proposal Form: The Cost Proposal Form requires vendors to provide the “total average proposed cost”. Since the form requires the vendor to use different pricing units (hours, reviews, months), how does the Department want us to calculate this number?

Answer:   ODJFS understands that the pricing contains different units of measurement and that a direct correlation cannot be made. We would still like to have the information completed as stated and an overall comparison will be made. If questions arise with any of the costs as stated ODJFS reserves the right to question the pricing submitted by the bidders. Vendors should use the calculations as stated on the Cost Proposal Form to come up with the "Total Average Proposed Cost"

Date: 3/18/2011

Inquiry: 21896


Question:   Regarding Section 1.2, Background on page 6: Utilization Review Program. It states that monthly certification requests are estimated around 98. Over what time period is this estimate?

Answer:   The estimated time used was state fiscal year 2010.

Date: 3/18/2011

Inquiry: 21885


Question:   Regarding Section 4.3 B., Special Reviews, page 20 Could you provide an estimate of the number of prior authorization denials and appeals per month/year?

Answer:   For state fiscal year 2010, there were 10 technical denials, 35 denials, and 6 appeals.

Date: 3/18/2011

Inquiry: 21889


Question:   Regarding Section 4.3, B. Pre-certification / Special Review Program on Page 20., Under number 6 and 7, could you provide an estimate of the number of denials and appeals per month/year?

Answer:   For state fiscal year 2010, there were 21 technical denials, 1 physician denial and no appeals.

Date: 3/18/2011

Inquiry: 21888


Question:   Regarding Section 1.2, Background on Page 4: Hospital Programs. It states there are 14 in-state psychiatric hospitals. Can you explain this number?

Answer:   ODJFS is unsure exactly what is being asked with this question. There are 14 in-state psychiatric hospitals.

Date: 3/15/2011

Inquiry: 21890


Question:   Regarding Section 1.2, Background on Page 6: Utilization Review Program, It states the selected vendor will develop a plan for utilization management that includes post-payment reviews. Could you please clarify the difference, if any, between retrospective and post-payment reviews? Are there any reviews conducted prior to payment? Are retrospective reviews in actuality post-payment reviews (after claims have been paid)?

Answer:   There is no difference between retrospective and post-payment reviews. The contractor will also be responsible for conducting some reviews prior to payment which consist of the pre-certification reviews and special reviews.

Date: 3/15/2011

Inquiry: 21887


Question:   Regarding Section 1.2, Background, Page 6: Utilization Review Program. It states that approximately 1,005 claims are reviewed on a monthly basis. In Section 4.3 C. page 21, Retrospective REview Program, it states that at a minimum the total number of reviews per month should be 1,500. Can you explain the difference and/or clarify the expectation?

Answer:   The current contractor reviews 1,005 claims per month. For the upcoming contract period, we are increasing the number of monthly reviews to be performed to 1,500.

Date: 3/15/2011

Inquiry: 21886


Question:   Regarding page 25, 4.3.H.1.4, In reference to MDS data availability-since this is a hospital utilization management program, is this reference in error?

Answer:   See Inquiry 21878

Date: 3/15/2011

Inquiry: 21882


Question:   Regarding page 20, 4.3.B.2, What medical necessity criteria are the current contractor using?

Answer:   See Inquiry 21876

Date: 3/15/2011

Inquiry: 21879


Question:   page 25, 4.3.H.1.4-references MDS data availablity. Since this is a hospital utilization management progran, is this reference in error?

Answer:   The reference is not in error. The statement in Section 4.3 H. 1., “ODJFS will provide data to the selected vendor in order to carry out the functions of the contract. Data to be provided may include:”. Multiple possible data elements are included in the RCP because certain data elements may be necessary for the completion of a health care study.

Date: 3/15/2011

Inquiry: 21878


Question:   What Medical Necessity Criteria is the current contractor using?

Answer:   The current contractor uses Milliman Care Guidelines.

Date: 3/15/2011

Inquiry: 21876


Question:   Are there any incumbent vendors for these services, or is this a new requirement? Is there a proposed budget for these services?

Answer:   Yes the incumbent vendor is Permedion. ODJFS will not disclose the allotted budget for this project.

Date: 3/8/2011

Inquiry: 21799


back

Inquiry period ended:  3/16/2011 8:00:00 AM