1460241-event.pdf

25 October 2026

Utilization Review (UR) DPHHS is seeking an Offeror(s) to provide utilization management and review services, which include level of care determination, as detailed herein.

25 October 2026

Open 10/21/2026, 2:00 PM MDT Type Request for Proposal Close 12/8/2026, 2:00 PM MST Number DPHHS-RFP-2027-0712AB Currency US Dollar

Sealed Until 12/8/2026, 2:00 PM MST

Payment Terms 0% 0, Net 30

25 October 2026

Contacts Amanda Battin Amanda.Battin2@mt.gov

Phone +1 406-444-9665

25 October 2026

Commodity Codes Commodity Code Description 0910 Computing Equipment & Software - Software 0911 Computing Equipment & Software - Software as a Service (SaaS) 0912 Computing Equipment & Software - Software Reseller 1003 Computing Services - Cloud Services 2606 Health Related - Health Facilities Management 2611 Health Related - Medicaid Analysis & Audit 2612 Health Related - Medicaid Billing 2613 Health Related - Medical Services 2614 Health Related - Medical Research 2615 Health Related - Nursing 2617 Health Related - Pharmaceuticals 2618 Health Related - Services 3954 Professional Services - Workforce Services

25 October 202625 October 202625 October 202625 October 202625 October 202625 October 202625 October 202625 October 202625 October 2026 mailto:Amanda.Battin2@mt.gov

Description The State of Montana, State Procurement Services Division (SPSD), on behalf of the Department of Health and Human Services, is issuing this Request for Proposal (RFP) to provide utilization management and review (UR) services, which include level of care determination, Preadmission Screening and Resident Review (PASRR) activities, functional assessments, prior authorizations, continued stay reviews, eligibility determinations, and special case reviews for the Montana Healthcare Program (MHP) in accordance with all federal and state rules/regulations and related state policies and procedures.

This organization must maintain its QIO or QIO-Like status throughout the contract period.

A more complete description of the Services, are provided in the Questions. Responses submitted to this RFP must comply with the instructions and procedures.

For assistance with eMACS functionality, such as Vendor Registration, How to respond to a bid (IFB) or Proposal (RFP), How to videos, see the eMACS Vendor Handbook. Additional resources can be found at: https://doa.mt.gov/SPSD/eMACS-Resources

For additional eMACS help not found within the handbook or website, contact the eMACS Help Desk at 406-444-2575.

Be sure to review and submit your response upon completion.

https://doa.mt.gov/SPSD/eMACS-Resources

Required to View Event

Prerequisites Required to Enter Bid

25 October 2026

1. Review and accept the Single Point of Contact information.

2. Review and accept the conflict-of-interest notice.

3. Review and accept the Optional Pre-Proposal Conference.

4. Review and accept the Quality Improvement Organization language. Offeror(s) certifying 'yes' have reviewed and can comply with the language included.

5.

Offeror(s) must certify they have reviewed and will comply with attachments A – T located in the Buyer Attachments, by marking ‘yes’ you certify that all documents have been reviewed and will be use to respond and will comply with all required attachments.

6. Review and accept the Q & A Board information.

7. Review and accept the Draft Contract as provided.

8. Review and accept the Montana Prevailing Wage Requirements information.

9.

Review and accept the insurance requirements. Offeror requesting change(s) or exception(s) to these requirements must submit the request(s) using the Contract Exception form. This form must be submitted by the deadline as listed on the Schedule of Events. The State will not consider any changes after the deadline. The State reserves the right to not accept any or all contract exceptions.

10. Federal funds are involved in this project. The awarded Contractor is required to have a Unique Entity ID # (UEI #; Register @ SAM.GOV) AND complete the Federal Form NDA889.

11. Review and accept the RFP Evaluation Process information.

12. Review and accept the Product Demonstration/Interview information.

13. Review and accept the Vendor Registration information.

14. Review and accept the Montana Time Zone information.

15. Review and accept the Registration with the Secretary of State information.

16. Review and accept the Debarment information.

17. Review and accept the RFP General Information.

18. Review and accept the Submitting a Proposal information.

19. Please review and accept the eMACS Handbook - Responding to Events. Additional resources are available at https://spb.mt.gov/eMACS-Resource

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Buyer Attachments

1. Attachment_A_Disability_Determination.pdf

2. Attachment_B_Brain_Injury_Screening.pdf

3. Attachment_C_Category_D_Services.docx

4. Attachment_D_Adolescent_Intensive_TGH.docx

5. Attachment_E_Adolescent_Acuity_Enhancement.docx

6. Attachment-F_Requirements_Response_Matrix_Base_and_UR_API.xlsx

7. Attachment_G_Module_Pricing_Schedules.xlsx

8. Attachment_H_Resource_Allocation_Schedules.xlsx

9. Attachment_I_IMD_for_HEART_Waiver.docx

0. Attachment_J_Service_Level_Agreements_UR.xlsx

1. Attachment_K_Access_Rule_Review.docx

2. Attachment_L_Technology_Matrix.xlsx

3. Attachment_M_CFCS-PCS_Program.docx

4. Attachment_N_Big_Sky_Waiver_Performance_Measures.pdf

5. Attachment_O_HEART_HCBS_Performance_Measures_Report.docx

6. Attachment_P_HEART_Quality_Improvement_Report.docx

7. Attachment_Q_HEART_TSS_CM_Metric_for_CMS.xlsx

8. Attachment_R_SDMI_Narrative_Report.pdf

9. Attachment_S_Applied_Behavior_Analysis.pdf

0. Attachment_T_EPSDT_DDP.docx

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Questions Required Questions

Group 1: Mandatory Requirements

Instructions:

To be eligible for consideration, an offeror must meet all mandatory requirements. The State will determine whether an offeror's proposal complies with the requirements. Offerors receiving a Fail in any of the mandatory requirements will be removed from further consideration.

1.1 Offeror must complete and upload the attached Business Information document.

1.2 Offeror must download and review the attached Scope of Work document. Thoroughly address each item in the document and upload it to this question.

1.3 Offeror must download and review the attached Offeror Qualifications document.

Thoroughly address each item in the document and upload it to this question.

1.4 Offeror must download and review the attached Budget Worksheet. Thoroughly address each item in the worksheet and upload it to this question. The Basis of Award will be based on XXXX.

Group 2: Contract Exceptions

Instructions:

An offeror may submit proposed contract exceptions to the draft contract issued with the RFP.

Offerors must use the Contract Exception template attached to this question. Offerors must detail why the exception is being sought and what specific effect it will have on the offeror's ability to respond to the RFP.

2.1

An offeror’s proposed contract exceptions will be made available to the evaluation committee. The contract exceptions requested will not be scored separately, but the evaluation committee may consider an offeror’s proposed contract exceptions when assigning points for scored criteria. A proposal may be deemed nonresponsive if the offeror’s proposed contract exceptions:

demonstrate the proposal does not satisfy RFP requirements; would violate law or materially alter the material provisions of the contract or RFP terms; or would alter or replace all or substantially all of the contract.

2.2 ******CONTRACT OFFICERS- PICK THE APPLICABLE QUESTION BELOW AND REMOVE THE

NON-APPLICABLE. QUESTION. DELETE THIS BEFORE POSTING*****

2.3 If the RFP is intended to result in the award of a contract to only one offeror, offerors requesting additions or exceptions to the contract terms shall submit them with their proposals. Exceptions submitted after deadline will not be considered.

2.4 If the RFP will establish a qualified vendor list or multiple contracts will be awarded as a result of this RFP, offerors requesting additions or exceptions to the contract terms shall submit them to the Q&A Board. Exceptions submitted after deadline will not be considered.

Group 3: Confidential Information

Instructions:

The State of Montana is required by both the Montana Constitution and its laws to permit the public to examine documents that are kept or maintained by the public agencies, other than those legitimately meeting the provisions of Montana Constitution, Mont. Code Ann. §§2-6-1001, et seq, Montana Procurement Act §§18-4-401, et seq., and Montana’s Uniform Trade Secrets Act, Mont.

Code Ann. §§ 30-14-401, et seq

3.1 Does your proposal contain confidential information? If you select Yes, another question will be generated, requiring an upload of your Trade Secret Affidavit. Offerors MUST also upload a copy of the response with all areas claimed as confidential or proprietary redacted under Supplier Attachments.

3.2 Offerors must upload a completed Trade Secret Affidavit.

Group 4: Verification of Nondiscrimination Against Firearms Entities/Trade Associations

Instructions:

Instructions: Offeror’s certification is made in compliance with and in reference to 30-20-301, MCA and the terms defined therein. If Offeror determines the provisions of 30-20-301, MCA do not apply to Offeror or the contract to be awarded under this RFP, Offeror shall submit a statement setting forth in detail the basis for such determination.

4.1

Offeror does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association during the term of any contract it is awarded under this solicitation; and b. Offeror will not discriminate against a firearm entity or firearm trade association during the term of any contract it is awarded as a result of this solicitation

4.2 The Contractor determines the provisions of 30-20-301, MCA do not apply to the contract, the Contractor shall submit a statement setting forth in detail the basis for such determination.

4.3 Please confirm whether you are a governmental entity, are not a “company” that exists to make a profit, or are a company with fewer than 10 full-time employees.

Group 5: Artificial Intelligence Disclosure Instructions:

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5.1 Was artificial intelligence technology used in the development or completion of any portion of this proposal?

5.2 I certify that all AI-generated content has been reviewed and validated by a named human subject-matter expert who claims responsibility for accuracy.

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Product Line Items Product Line Items

There are no Items added to this event.

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Service Line Items Service Line Items

1.

# Item Name, Commodity Code, Description Allow

Alternates Qty. UOM Requested Service Delivery

S1 Lump Sum Total 1 LS - Lump Sum

Lump Sum Total - Service Line Items

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