6-SHE130921 General Requirements.pdf

SHE130921 Medicaid 1115 Waiver

GENERAL REQUIREMENTS

1.0 SCOPE:

Salt Lake County Contracts and Procurement, on behalf of Salt Lake County Sheriff’s Office Jail Health Services Division, is seeking a qualified and experienced contractor to provide Medicaid claim submission and management services under the 1115 Medicaid Waiver. The selected vendor will be responsible for preparing, submitting, and managing all eligible Medicaid claims for incarcerated individuals who received Medicaid-covered services or medications during the final 90 days of their incarceration. This initiative supports the County’s efforts to improve continuity of care, enhance reimbursement accuracy, and ensure compliance with State and Federal Medicaid requirements.

Initial implementation will focus exclusively on Medication-Assisted Treatment (MAT) participants (approximately 90 inmates) and will eventually expand to include all inmates receiving Medicaid-eligible medical care as the program matures.

The contractor must be able to Interface seamlessly with the County’s Saphire Health EHR system to enable secure data exchange, eligibility verification, and claim submission. Comply with all County IT standards, security, and privacy policies governing inmate health data. Provide training to County staff on identifying and validating Medicaid-eligible claims.

The contractor will be required to provide a dedicated Account Manager to oversee all billing operations. and add billing specialists as needed based on claim volume. The Contractor will be required to submit monthly reports detailing claim submissions, reimbursements, denials, and resolution timelines. Attend quarterly performance review meetings with Health Services representatives and provide an annual compliance audit summary and recommendations for process improvement.

The Sheriff’s Office and Jail Health Services shall

• Provide inmate demographic, booking, custody, and release data necessary for eligibility verification and claims processing.

• Facilitate secure access to jail medical records and EHR documentation for Medicaid-eligible encounters.

• Approve and support technical integrations between County/jail systems and the Contractor’s billing platform.

• Coordinate among internal departments and healthcare providers to ensure timely and complete transmission of encounter and billing data.

• Establish service-level expectations for response times, issue resolution, and data exchange. Collaborate with Contractor to address compliance issues and implement corrective actions.

• Review and approve vendor invoices per County financial policies.

2.0 CONTENTS:

If any provision or specification in this “Request for Bids and Resulting Contract” (RFC) is ambiguous or is disputed by a bidder, the bidder must notify the County Contracts and Procurement Division prior to the opening of the bids. No dispute or protest concerning the ambiguity of these specifications or provisions of this RFC shall be accepted following opening of the bids.

3.0 QUESTIONS:

Questions shall be submitted through Bonfire – Utah Public Procurement Portal.

Questions are due prior to the question date and time specified. If a question/answer changes the RFC document, the change will be released in an addendum. Do NOT contact the Agency, Division, Department, or other County officers or employees.

4.0 CONTRACT TERM:

The contract resulting from this solicitation will become effective on the date of execution with a six (6) year term. The County reserves the right to review the contract on a regular basis regarding performance and cost analysis and may negotiate price and service elements during the term of the contract.

5.0 PRE-BID CONFERENCE:

A virtual pre-bid meeting will be held on June 10th at 1:00pm. To request a seat at this conference, please send an invitation request via email to Aaron Stone at AStone@saltlakecounty.gov. Attendance is not mandatory, but it shall be the sole responsibility of the bidder to attend this conference. Bidders not attending do so at their own risk. The written questions submitted, along with any other additional information pertaining to the clarification of specifications, will be discussed in detail at this conference. Bidders shall thoroughly familiarize themselves with this solicitation document including specifications prior to attending the conference. Verbal statements or information given at a site visit are not binding on the bidder or the County unless released in a bid amendment.

6.0 ANNUAL PURCHASES:

No minimum or maximum quantity or purchases under this contract can be specified. For information purposes only and not as a guarantee of usage by the County, the County anticipates an estimated annual cost of $10,000.00.

mailto:AStone@saltlakecounty.gov

7.0 PRICING:

Bidders are to complete and submit the Pricing Schedule attachment (found in the Supporting Documentation area of the bonfire portal) as part of their bid. Pricing evaluation will be based on the lowest percentage of costs as offered on respective bidders’ Pricing Schedule.

The bid pricing being offered must include any potential delivery charges and be shipped FOB Destination, Freight Pre-Paid.

8.0 AWARD:

Salt Lake County may award bids and contracts to vendors through a preference system. Please refer to the preference attachment.

Salt Lake County may reject any or all bids if it is deemed to be in the best interest of the County.

Award will be to the lowest responsive, responsible bidder bidding the lowest percentage of costs as shown on respective bidders’ Pricing Schedule.

8.0 BILLING AND INVOICING:

The County requires awarded Contractor to set up unique customer accounts for each of the three SLCO Divisions (Sheriff’s Office, SLCO Health, and SLCO Animal Services) and bill each division separately. Divisions may notify the Contractor if they want locations combined into one billing or billed on separate accounts.

13.0 PRICE ESCALATION / DE-ESCALATION:

Pricing is to be guaranteed for the term of the contract.

10.0 REFERENCES/EXPERIENCE:

Bidder must have a minimum of 3 years’ experience submitting Medicaid eligible claims, be licensed and insured in the state of Utah and be able to comply with the 1115 waiver requirements, and provide a minimum of two professional references (See the References attachment found in the Supporting Documentation area of the bid portal).

13.0 TRAINING:

Contractor is to provide training to Salt Lake County Sheriff’s Office Health Services Employees on determining eligible Medicaid claims and any other elements necessary for successful contract performance.

9.0 BACKGROUND CHECKS:

Bidders must submit the original Bureau of Criminal Investigation (BCI) criminal histories for each employee who may have access to medical records, inmate files, electronic health records and related information, no older than forty-five (45) days as part of their bid submission. Bidders may provide this documentation via e-mail to Serena Briggs SerBriggs@saltlakecounty.gov prior to or within 10 business days of bid closing.

Background check documentation must be submitted prior to award. Bidders not providing this information within the time allotted will be ineligible for award, and the award will be made to the next lowest responsive, responsible bidder. The County reserves sole authority to determine responsiveness of bids as a result of the background check evaluation process. Bidders may refer to the following website for acquiring background check documentation through the Utah Department of Public Safety, Bureau of Criminal Investigation:

https://bci.utah.gov/criminal-records/obtain-a-copy-of-your-own-criminal-history-record/

If the BCI is showing “Criminal History Verified” with the arrest history attachments, staff members that have an arrest(s) that do not have dispositions must be able to provide SLCo Sheriff’s Office with the court dispositions. Non-compliant staff members will be unable to perform any services under an awarded contract. All manager(s) and office staff who have access to any communication with Salt Lake County Sheriff’s Office are required to submit the original BCI criminal background with a seal.

Any employee hired by Contractor after contract award must be added by submitting the original BCI criminal history no older than forty-five days (45) prior to providing services and receiving access to any communication with Salt Lake County Sheriff’s Office. Applications must be sent via email to Serena Briggs SerBriggs@saltlakecounty.gov within 10 days of hire or acquisition. Non-compliant staff members will be unable to perform any services under an awarded contract. The company will ensure that all managers and other employees have enough experience and/or training can perform their duties lawfully, safely, properly, and effectively.

Owners, managers, and office staff must be in compliance with the criteria listed below:

a. Shall not have been convicted in any court in the United States of a violent felony or similar crime(s) as defined in UCA 76-3-203-5, of any assaults or other crimes against a Law Enforcement Officer or Government Official, or sexual offenses of any kind, shall not have been declared by any court in the United States incompetent because of mental defect and/or disease and not fully restored.

b. If the owner(s), managers, or office staff are under investigation for any of the offenses listed above, the SLCo Sheriff’s Office reserves the right to deny the application of any non-compliant individual(s).

c. Shall not be a Registered Sex Offender in the United States. If an individual performing services under the contract is placed on the Sex offender Registry at any time during the mailto:SerBriggs@saltlakecounty.gov https://bci.utah.gov/criminal-records/obtain-a-copy-of-your-own-criminal-history-record/ mailto:SerBriggs@saltlakecounty.gov contract, contractor must notify the SLCo Sheriff’s Office within 10 days via email or certified U.S. Mail.

d. Shall not have convictions including pleas in abeyance, classified as a felony or misdemeanor crime(s) involving violence, moral turpitude, weapons, illegal use or possession of any substance, domestic violence, resisting arrest, obstruction of justice, or thefts of any kind within the last five (5) years. Sentencing must be satisfactorily completed, included but not limited to probation and/or parole-with the date of completion also not within the last five (5) years. Employees who show a pattern of criminal behavior may be rejected.

e. Shall not have been convicted of any other crime(s) that when considered with the duties and responsibilities of a manager or office staff employee as outlined in this agreement, the SLCo Sheriff’s Office considers that the best interest of the public is not served.

10.0 PARTIAL BID SUBMISSION:

Submission of a partial listing of items on the bid schedule sample list may result in your bid being deemed non-responsive.

11.0 NON-EXCLUSIVE CONTRACT:

The contract to be awarded shall be non-exclusive. Salt Lake County reserves the right to purchase, at its discretion, any product or service covered by the resulting contract from other sources during the term of the contract.

12.0 AUDITING:

The vendor agrees to make available to Salt Lake County all records; invoices, or documentation relative to this contract, and to assist Salt Lake County personnel in performing periodic audits and price checks. Bidder agrees to provide requested information within 5 working days.

14.0 TERMS AND CONDITIONS

Bidder agrees that if awarded a contract under this solicitation, Salt Lake County’s Terms and Conditions, attached, will apply. In the event the bidder’s terms and conditions conflict with Salt Lake County’s terms and conditions, Salt Lake County’s terms and conditions will control.

15.0 REQUIRED INSURANCE POLICIES:

GENERAL INSURANCE REQUIREMENTS FOR ALL POLICIES.

A. Any insurance coverage required herein that is written on a “claims made” form rather than on an “occurrence” form shall (i) provide full prior acts coverage or have a retroactive date effective before the date of this Agreement, and (ii) be maintained for a period of at least 3 (three) years following the end of the term of this Agreement or contain a comparable “extended discovery” clause. Evidence of current extended discovery coverage and the purchase options available upon policy termination shall be provided to the County.

B. All policies of insurance shall be issued by insurance companies licensed to do business in the State of Utah and either:

(i) Currently rated A- or better by A.M. Best Company;

—OR—

(ii) Listed in the United States Treasury Department’s current Listing of Approved Sureties (Department Circular 570), as amended.

C. Bidder shall furnish certificates of insurance, acceptable to the County, verifying the foregoing matters concurrent with the execution hereof and thereafter as required.

D. In the event any work is subcontracted, Bidder shall require its subcontractor, at no cost to the County, to secure and maintain all minimum insurance coverages required of the Bidder hereunder.

E. In the event that governmental immunity limits are subsequently altered by legislation or judicial opinion, Bidder shall provide a new certificate of insurance within 30 (thirty) days after being notified thereof in writing by the County, certifying coverage in compliance with the modified limits or, if no new limits are specified, in an amount acceptable to the County.

F. All required certificates and policies shall provide that coverage thereunder shall not be canceled or modified without providing 30 (thirty) days prior written notice to the County in a manner approved by the County District Attorney.

G. In the event Bidder fails to maintain and keep in force any insurance policies as required herein, County shall have the right at its sole discretion to obtain such coverage and reduce payments to Bidder for the costs of said insurance.

REQUIRED INSURANCE POLICIES.

Bidder agrees to secure and maintain the following required policies of insurance in accordance with the general insurance requirements set forth in the preceding subsection:

A. Workers’ compensation and employer’s liability insurance as required by the State of Utah unless a waiver of coverage is allowed and acquired pursuant to Utah law. This requirement includes Bidders who are doing business as an individual and/or as a sole proprietor as well as corporations, limited liability companies, joint ventures and partnerships. In the event any work is subcontracted, Bidder shall require its subcontractor(s) similarly to provide workers’ compensation insurance for all of the latter’s employees, unless a waiver of coverage is allowed and acquired pursuant to Utah law.

B. Commercial general liability insurance on an occurrence form with the County as an additional insured, in the minimum amount of $1,000,000 per occurrence with a $2,000,000 general policy aggregate and $2,000,000 products completed operations policy aggregate. The policy shall protect the County, Bidder, and any subcontractor from claims for damages for personal injury, including accidental death, and from claims for property damage that may arise from Bidder’s operations under this Agreement, whether performed by Bidder itself, any subcontractor, or anyone directly or indirectly employed by either of them. Such insurance shall provide coverage for premises operations, acts of independent Bidders, and completed operations.

C. Commercial automobile liability insurance that provides coverage for owned, hired, and non-owned automobiles, with the County as an additional insured, in the minimum amount of $1,000,000 per occurrence.