indiana department of administration prior authorization & utilization management services...
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INDIANA DEPARTMENT OF ADMINISTRATION
Prior Authorization & Utilization Management ServicesREQUEST FOR PROPOSAL 13-78
on behalf ofOffice of Medicaid Policy and Planning
INDIANA DEPARTMENT OF ADMINISTRATION
GENERAL INFORMATION
• Attendee Sign-In Sheet
• Sign-In Sheet and PowerPoint will be posted on State’s Solicitation Website
INDIANA DEPARTMENT OF ADMINISTRATION
RFP QUESTIONS AND ANSWERS
Questions answered verbally today are not official nor binding and should be submitted in writing if it will affect your proposal response (Q/A Template – Attachment I)
All questions must be submitted in writing by 3:00 PM EST on April 19, 2013
Email: [email protected]
Fax: 317.232.7312
State of Indiana RFP 13-78Prior Authorization and Utilization Management ServicesAttachment I - Question and Answer Response Template
Respondent Name:Please Complete Yellow Shaded Regions
Question No.
RFP Section Page Topic Specific Question/Inquiry
1 Please make a selection2 Please make a selection3 Please make a selection4 Please make a selection5 Please make a selection6 Please make a selection7 Please make a selection8 Please make a selection9 Please make a selection
10 Please make a selection11 Please make a selection12 Please make a selection13 Please make a selection14 Please make a selection15 Please make a selection16 Please make a selection17 Please make a selection18 Please make a selection19 Please make a selection20 Please make a selection21 Please make a selection22 Please make a selection23 Please make a selection24 Please make a selection25 Please make a selection26 Please make a selection27 Please make a selection28 Please make a selection29 Please make a selection30 Please make a selection31 Please make a selection32 Please make a selection33 Please make a selection34 Please make a selection35 Please make a selection
INDIANA DEPARTMENT OF ADMINISTRATION
ACCESSING RFP DOCUMENTS
www.in.gov/idoa/proc
INDIANA DEPARTMENT OF ADMINISTRATION
ACCESSING RFP Documents
INDIANA DEPARTMENT OF ADMINISTRATION
KEY RFP DATES
INDIANA DEPARTMENT OF ADMINISTRATION
PURPOSE AND SCOPE OF RFP 13-78
The purpose of this RFP is to select a vendor that can satisfy the State’s need for Prior Authorization and Utilization Management services for IHCP enrollees excluding those enrolled in the managed care portion of the program. The PA function shall cover all products and services for which the State’s medical policy requires PA, except pharmacy services.
Contractor will receive PA requests from providers via telephone, fax, web-based system or in writing and will process them in a timely manner, including interfacing with IndianaAIM. As part of the PA services, Contractor shall set up a PA call center and have in place other technologies such as faxes and web-based systems to accept PAs. Additionally, Contractor will be responsible for providing Utilization Management services, which include Reviews for Elective Inpatient Admissions, Traumatic Brain Injury Services, Peer Review Studies and Focused Studies.
INDIANA DEPARTMENT OF ADMINISTRATION
RFP OUTLINE
INDIANA DEPARTMENT OF ADMINISTRATION
BUSINESS PROPOSAL
Company Financial Information (Section 2.3.3)Confidential information must be kept separate from the proposal in both hard and soft copy
INDIANA DEPARTMENT OF ADMINISTRATION
COST PROPOSAL
The cost proposal is comprised of sections for Prior Authorization, Utilization Management and Implementation respectively.
State of Indiana, RFP 13-78Attachment G - Cost Proposal - Updated
Respondent Name:
1. Prior Authorization Services
A. Prior Authorization
$ per Processed Line Request
B. Prior Authorization - TBI and PRTF
$ per Processed Line Request
Note: TBI and PRTF Prior Authorizations are priced separetly dude to their complex nature compared to other services.
C. Prior Authorization - Advanced Imaging
$ per Processed Line Request
Note: Advanced Imaging Prior Authorizations are applicable only after rule change by State to require PA for Advanced Imaging.
2. Utilization Management Services
A. Concurrent Reviews for Elective Inpatient Admissions
Review Type $ per Completed Review
Concurrent Review
Note: Concurrent reviews apply only to elective inpatient admissions.
B. TBI Services
UM Service Type Annual Fixed Cost
TBI Services
C. Peer Review and Focused Studies
Review Type Annual Fixed Cost
Peer Reviews
Focused Studies
D. Hourly Rates for Consultation Services*
Hourly Cost ($/Hr) Maximum Hours Cost Ceiling
-$
-$
-$
-$
-$
-$
-$
-$
-$
Total Potential Cost: -$
3. First-Year Implementation Costs
Total First-Year Implementation Costs: -$
Please Complete Yellow Shaded Regions
Instructions: Please fill in the cells shaded yellow. These items will be used to assign Cost points (20 max).
Enter the per line request Prior Authorization charge the Respondent proposes to provide the services described in Attachment D and the rest of the RFP. (Excluding PA for TBI and PRTF)
Note: A “processed” line request is defined as a line-item of a prior authorization request that has been approved, modified, rejected, denied, or determined that prior authorization is not required. Contractor may only invoice the State once per PA processed. For example, if a PA is modified and provider requests an Administrative Review, which is later approved, the PA can only be invoiced once.
Enter the per line request Prior Authorization charge the Respondent proposes for Prior Authorization for TBI and PRTF.
Enter the per line request Prior Authorization charge the Respondent proposes for Prior Authorization for Advanced Imaging (If different from section 1.A)
INDIANA DEPARTMENT OF ADMINISTRATION
COST PROPOSAL (Cont.)
The cost proposal is comprised of sections for Prior Authorization, Utilization Management and Implementation respectively.
State of Indiana, RFP 13-78Attachment G - Cost Proposal - Updated
1. Prior Authorization Services
A. Prior Authorization
$ per Processed Line Request
B. Prior Authorization - TBI and PRTF
$ per Processed Line Request
Note: TBI and PRTF Prior Authorizations are priced separetly dude to their complex nature compared to other services.
C. Prior Authorization - Advanced Imaging
$ per Processed Line Request
Note: Advanced Imaging Prior Authorizations are applicable only after rule change by State to require PA for Advanced Imaging.
2. Utilization Management Services
A. Concurrent Reviews for Elective Inpatient Admissions
Review Type $ per Completed Review
Concurrent Review
Note: Concurrent reviews apply only to elective inpatient admissions.
B. TBI Services
UM Service Type Annual Fixed Cost
TBI Services
C. Peer Review and Focused Studies
Review Type Annual Fixed Cost
Peer Reviews
Focused Studies
D. Hourly Rates for Consultation Services*
Hourly Cost ($/Hr) Maximum Hours Cost Ceiling
-$
-$
-$
-$
-$
-$
-$
-$
-$
Total Potential Cost: -$
3. First-Year Implementation Costs
Cost Ceiling (The State will not pay above this amount)
Total First-Year Implementation Costs: -$
Implementation Area
1. Hardware and system costs2. Software and other licenses3. Other implementation costs (Please Specify)
Consultant Type
Enter the implementation costs the Respondent proposes to charge the State in addition to the rates proposed in Section 1. The cost ceiling proposed here is the maximum allowable amount. The Contractor will be required to document actual implementation costs and support any charges invoiced to the State under this line item.
*Note: Hourly rates for consultation services will only be charged when ad-hoc consultation is needed outside of the services described within the Scope of Work.
INDIANA DEPARTMENT OF ADMINISTRATION
MINORITY AND WOMEN’S BUSINESS ENTERPRISE
Complete Attachment A, MWBE Form- Include sub-contractor letters of commitment Goals for this RFP:
- 8% Minority Business Enterprise
- 8% Women’s Business Enterprise
INDIANA DEPARTMENT OF ADMINISTRATION
MINORITY AND WOMEN’S BUSINESS ENTERPRISE
$$$$$$
INDIANA DEPARTMENT OF ADMINISTRATION
INDIANA ECONOMIC IMPACT
The State defines FTE as a measurement of an employee's productivity on a specific project or contract. A FTE of 1 would mean that there is one (1) worker fully engaged on a project; forty (40) hours a week, fifty-two (52) weeks a year. If there are two (2) employees each
spending 1/2 of their working time, 20 hours per week, on a project that would also equal 1 .$$$$$$
INDIANA DEPARTMENT OF ADMINISTRATION
RFP SCORING AND EVALUATION
INDIANA DEPARTMENT OF ADMINISTRATION
QUESTIONS AND ANSWERS
INDIANA DEPARTMENT OF ADMINISTRATION
ADDITIONAL INFORMATIONIDOA PROCUREMENT LINKS AND NUMBERS
http://www.in.gov/idoa/2354.htm1-877-77BUYIN (8946) For Vendor Registration Questions
http://www.in.gov/idoa/2464.htmFor Inquiries Regarding Substantial Indiana Economic Impact
A. Link to the developing “one stop shop” for vendor registry with IDOA and Secretary of State. http://www.in.gov/idoa/2467.htm
B. Secretary of State of Indiana: Can be reached at (317) 232-6576 for registration assistance. www.in.gov/sos
C. Vendor Handbook: Online version available at http://www.in.gov/idoa/files/vendor_handbook.doc
D. Minority and Women Owned Business Enterprises: http://www.in.gov/idoa/files/Certification_List(48).xls for table of IDOA certified MBEs and WBEs. For more WBE’s information http://www.in.gov/idoa/2352.htm
E. RFP posting and updates: Go to http://www.in.gov/idoa/2354.htm (select “State of Indiana Opportunities” link) Drag through table until you find desired RFP/RFI number on left-hand side and click the link.