Addendum No. 2 - Questions and Answers~1.pdf

Revised 04/03/2023

Request For Proposals for

Inpatient Concurrent Review

ADDENDUM NO. 2 to RFP DBH 25-61

I. QUESTIONS AND ANSWERS

1. Question: Will the attachments be furnished in a fillable format?

Answer: The Fillable Forms were posted in ePro on January 13, 2026.

2. Question: Will we receive the presentation PowerPoint?

Answer: The PowerPoint from the Proposal Conference was posted in ePro on January 13, 2026.

3. Question: Can the County please clarify the vendor's role for discharge planning and tracking barriers?

Answer: The vendor does not have a role in discharge planning or in tracking discharge barriers; these responsibilities belong to the hospital.

4. Question: Can the County please define what circumstances would warrant an ad hoc meeting for the Medical Doctor (MD)? Can you define the purpose and expected frequency of the prescheduled meetings?

Answer: Contractor shall designate a licensed Medical Doctor (MD) to be available for consultation, respond to complex hospital inquiries, and participate in peer-to-peer discussions when needed to support medical necessity determinations and resolve care disputes in a clinically appropriate and timely manner. Contractor’s MD or designee must attend ad hoc and prescheduled meetings as determined by the County. Purpose and frequency to be determined.

5. Question: Can the County please define the purpose and expected frequency of the prescheduled meetings?

Answer: Prescheduled meetings are intended for progress review and discussion of ongoing or systemic issues and are expected to occur on a regular basis (e.g., monthly or quarterly) as determined by the County.

6. Question: Does DBH expect the contractor to formally escalate repeated hospital non-compliance with notification or documentation timeliness standards, or only to track and report such trends to DBH?

Answer: DBH requires the Contractor to formally escalate instances of repeated hospital non-compliance with notification or documentation timeliness standards, and the Contractor is responsible for tracking and reporting these trends to DBH.

7. Question: If deficiencies are identified through audits or evaluations, does DBH have defined timelines or escalation protocols for submission and resolution of corrective action plans?

Answer: This will be considered on a case-by-case basis. A typical corrective action plan is required within 30 days of notification of a deficiency. However, that timeline may fluctuate based on multiple factors, including, but not limited to, the urgency/severity of the deficiency and the feasibility of correction within that timeframe. Escalation protocol would likewise be commensurate with the severity of the deficiency and action and/or inaction of the contractor.

8. Question: Will the County confirm they want the program rate sheets included in the Technical Response rather than separated into their own response?

Answer: Rate sheets should be submitted along with Attachment J (Rates). See Attachment I for a sample.

9. Question: Will the County please provide the number of participants served by fiscal year, which the contract should use to build its pricing models?

Answer: The number of participants served will be approximately between 11,000 – 16,000 per fiscal year (July 1 through June 30).

10. Question: Attachment L is marked as a Reference Document, but it has lines for a signature at the bottom, indicating it is something that requires signatory acknowledgement.

The attachment is not included on the Proposal Submission Checklist. Will the County confirm that Attachment L does require a signature? And if so, where should Attachment L be included in the response?

Answer: Attachment L (Attestation Regarding Ineligible/Excluded Persons) is a reference document as referred to in Article V.A.26.b. This document is not required to be submitted with a proposal but will be included and signed in the tentative contract to the awarded vendor.

11. Question: Based on the statements of experience request in [Article XI.C. Proposal Format] 6.h. and 6.j. specifically, this may be a very extensive list of contracts. Can the County please confirm they want to see only relevant service contracts of similar size and scope?

Answer: The County does not request a minimum or maximum number of contracts as reference; however, proposers should submit any relevant contracts of similar size, scope, and amounts to support their proposal.

12. Question: Will DBH provide volume estimates for each Stated Fiscal Year?

Answer: Estimated Number of Reviews for each Stated Fiscal Year:

2026-27: 11,000

2027-28: 12,000

2028-29: 15,009

2029-30: 15,459

2030-31: 15,923

13. Question: Will DBH provide the concurrent denial rate for these services?

Answer: It is up to the provider to report the denial rate to DBH.

14. Question: Will DBH allow for either [Milliman Care Guidelines (MCG)] or InterQual medical criteria to be used?

Answer: DBH will not allow for either MCG or InterQual medical criteria to be used.

15. Question: What is the current auto approval percentage that is being used?

Answer: There is no auto approval percentage rate.

16. Question: Does the Medical Doctor need to be California licensed?

Answer: DBH recommends that the Contractor ensure that the Medical Doctor maintains an active California medical license, that may be negotiable with approval from DBH to the extent authorized by law.

17. Question: Do [Utilization Management (UM)] reviewers need to be [Registered Nurses (RN)], or can we use [Social Workers (SW)]? Do all need to be licensed in California?

Answer: DBH requires that UM reviewers be Registered Nurses, Licensed Clinical Therapist, Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, Licensed Psychologist or Licensed Social Workers, to serve in this role as permitted by program requirements. All reviewers are required to hold an active California license, that may be negotiable with approval from DBH to the extent authorized by law.

18. Question: Are we required to use Attachment B or can we use our own [Table of Contents] TOC as long as it is similar to the attachment?

Answer: Response to the RFP must be in the form of a proposal package as detailed in Article XI.B (Proposal Presentation). Proposals should utilize the provided attachments included in the RFP. If a proposer will include their own TOC, also reflect the TOC headers on Attachment B.

19. Question: Should a redacted copy of the response be included? [Reference to Article III.L (Public Records Act) “If a Proposer believes that any portion of its proposal is exempt from public disclosure, it must indicate the specific portions believed to be confidential and not subject to disclosure on Attachment E.”]

Answer: A redacted copy of the response is not necessary. As the directions indicate in Article III.L Public Records Act, the proposer should identify the specific portion which they believe is confidential/exempt from the Public Records Act and mark it as “Confidential”.

20. Question: If submitting on ePro, should the proposal be submitted as one file?

Answer: Proposals can be submitted as one file or multiple at once.

21. Question: If submitting on ePro, is there a file size limit?

Answer: There are no size restrictions, multiple attachments can be uploaded at once.

22. Question: Are bidders required to hold a California business license at the time of proposal submission, or may the license be obtained after contract award?

Answer: Bidders must obtain and hold a California business license prior to the start of the tentative contract award. Bidders are not required to obtain a California business license at the time of proposal submission.

23. Question: Can you please share the expected monthly/ Annual proposed inflow volume for the scope mentioned in the RFP?

Answer: Estimated Number of Reviews for each Stated Fiscal Year:

2026-27: 11,000

2027-28: 12,000

2028-29: 15,009

2029-30: 15,459

2030-31: 15,923

24. Question: Are there any offshore restrictions for the scope mentioned in the RFP? If yes, Will San Bernardino County be open to a vendor utilizing near-shore/ off-shore RNs/MDs to provide the services mentioned in the RFP?

Answer: This can be open for discussion.

25. Question: Do the Utilization Review nurses/professionals required to have nursing/medical licenses from the state of California?

Answer: Utilization Review nurses/professionals are required to hold active nursing or medical licenses issued by the State of California.

26. Question: Which evidence-based clinical criteria tools are used to review the medical necessity of psychiatric claims on behalf of DPH? (e.g. InterQual, ASAM Criteria, MCG, etc.)

Answer: DBH currently does not have any evidence-based criteria tools, this is decided by the Contractor.

27. Question: Please define the criteria/fields submitted within TARs (treatment authorization log).

Answer: All criteria and fields within Treatment Authorization Requests (TARs) are required to be fully completed.

28. Question: Please elaborate on the process of DBH’s annual evaluation of the program. What can be expected for Contractor’s participation?

Answer: The Contractor shall ensure that appropriate staff are available to provide any additional documentation requested that is not immediately available during the review.

29. Question: Is the licensed MD to be available for consultation required to have a medical license from the state of California? Is out of state licensure considered?

International?

Answer: Yes, a licensed MD who is required to be available for consultation under a contract in California generally must hold a valid medical license issued by the California Medical Board.

30. Question: Will DBH provide the current call volumes for these services?

Answer: Yes, in most cases DBH will provide the current call volumes for the services covered under the contract or program evaluation, so that Contractors can plan staffing, workflows, and performance expectations appropriately.

31. Question: In Section 5.b.2, Describe the Agency’s experience in case management and concurrent review activities, for large organizations, is this referring to our experience with coordination and communication with Case Management teams and how referrals to case management services are made?

Answer: Yes. This refers to the Agency’s experience in coordinating and communicating with Case Management teams.

32. Question: In Section 5. b. 14. Estimate the number of unique or unduplicated clients expected to be served and that number will be generated and/or affected (i.e. community outreach). Are 'members/patients' and 'clients' the same thing in this context?

Should only direct service recipients count as 'clients,' or does this also include people reached through community outreach?

Answer: Yes, and only direct service recipients are counted as “clients.”

“Members/patients” may be used interchangeably in some contexts, but for the purposes of this section, the term “clients” refers specifically to individuals receiving direct services.

33. Question: The requirement [in Section IV.C Program Description] states the contractor must assign a dedicated team or staff member solely responsible for servicing DBH.

Will the County confirm that the resource should be dedicated to the program, but not necessarily a full-time team or staff member?

Can the County clarify what level of staff should be considered as dedicated staff to meet the requirements of the RFP.

What is the County's expectation to meet the requirement of a dedicated to a staff member? We are looking [for] job title (level of staff), what kind of hours are expected?

Answer: Yes, the Contractor must assign a dedicated team or staff member; however, the staff member is not necessarily solely responsible for servicing DBH.

Dedicated staff should include licensed clinicians and medical doctors (MDs).

The dedicated team is expected to review a high volume of psychiatric inpatient cases. The team should have the expertise and capacity to manage large caseloads while ensuring timely and thorough case reviews.

34. Question: The Rate Proposal template indicates that pricing should be calculated by multiplying the “clients served per fiscal year” by the “service fee per review.” Please confirm whether the “service fee per review” refers to a completed Treatment Authorization Request (TAR) conducted at the conclusion of a beneficiary’s admission.

Answer: The service fee applies when the review is completed.

35. Question: For the Rate Proposal [Attachment I], please clarify the definition of “clients served per fiscal year,” including whether this metric reflects unique beneficiaries or individual admissions.

Please also confirm whether a vendor may submit invoices for the same beneficiary more than once within a fiscal year if the beneficiary is discharged and subsequently readmitted, either to the same facility or to a different facility.

Answer: Clients Served per Fiscal Year, as indicated on attachment I, refers to the number of unduplicated individuals expected to be served through the County’s Fiscal year (July 1 through June 30). Attachment I is a sample; proposers may submit expanded and more detailed Rate Proposals along with Attachment J to reflect anticipated fees and/or costs. And yes, invoices can be submitted for the same beneficiary/member more than once within the same fiscal year.

36. Question: Should implementation costs be included in Year One per-member pricing, or should the contractor identify implementation costs as a separate line item?

Answer: Implementation costs are a separate line item.

37. Question: Does the MOU need to be signed by both the bidder and any subcontractors? Or will just the bidder's signature suffice?

Answer: The MOU must be mutually signed by both the bidder and the subcontractor.

38. Question: Please confirm that electronic signatures on the MOU are acceptable for ePro submission.

Answer: Yes, the County recognizes electronic signatures as “original signatures” on the MOU and are acceptable for ePro submission as indicated on Section X.A: “the Primary Agency must submit a written Memorandum of Understanding (MOU) with that agency or agencies with original signatures to DBH (or through ePro if electronically submitted) as part of the proposal.”

39. Question: How does the County define the applicable “industry” for purposes of these comparisons such as healthcare services or another classification [in section XII.

Proposal Evaluation and Selection]?

Answer: Industry averages use external, independent peer entities with comparable healthcare service offerings, operating models, and financial structures.

40. Question: What sources will the County use to determine the applicable industry average benchmarks [in section XII. Proposal Evaluation and Selection]?

Answer: Industry average benchmarks will be based on publicly available, independent healthcare industry data and peer analysis derived from authoritative governmental and industry sources.

41. Question: Attachment L is listed as a Reference Document and is not included in the Proposal Checklist. However, it includes a set of signature and date lines, indicating it needs to be acknowledged. Please confirm that Attachment L is solely for reference only and does not need to be signed and included with our response.

If Attachment L does need to be included with our response, please provide guidance as to where/how the County expects it to be presented.

Answer: Attachment L (Attestation Regarding Ineligible/Excluded Persons) is a reference document as referred to in Article V.A.26.b. This document is not required to be submitted with a proposal but will be included and signed in the tentative contract to the awarded vendor.

42. Question: Will DBH provide the contractor with a recurring eligibility file (including indigent and Medi-Cal members)? If so, what format, data elements, and cadence are expected?

If not, what methods (e.g., 270/271, County system access, hospital-provided information) should the contractor use to verify eligibility?

Answer: DBH does not provide an eligibility file, but the contractor will need to verify eligibility by reviewing the Explanation of Benefits (EOB) on the DHCS portal.

43. Question: Beyond submitting completed TARs, does DBH require a structured electronic authorization file (e.g., daily/weekly) to support claims payment, admin day tracking, and cost reporting? If yes, what file layout, transmission method, and frequency are required? Please confirm that it is the responsibility of the facility to send the TAR.

Answer: Yes. DBH requires a PDF folder containing the completed TARs to be maintained in a shared file, with submissions provided daily. It is the responsibility of the facility to send the completed TARs to the contractor, and the contractor will send the completed TARs to DBH.

44. Question: For Medi-Cal beneficiaries enrolled in managed care plans, does DBH expect the contractor to transmit concurrent review/authorization decisions directly to the Medi-Cal plans, or only to DBH (as the MHP), with DBH responsible for any downstream communication to plans?

Answer: The transmit concurrent review/authorization will go directly to DBH.

45. Question: Can DBH confirm that the scope of this contract is limited to concurrent (continued-stay) and retrospective review (e.g., ARMC backlog), and does not include preadmission/precertification review? If any preadmission or precertification activity is expected, under what circumstances and for which populations? The RFP states that hospitals must submit notification of admission within 24 hours of the patient’s admission, does this mean the first 24 hours are authorization free?

Answer: Yes. The scope of this contract is limited to concurrent (continued-stay) and retrospective review and does not include preadmission or precertification review.

Hospitals have the first 24 hours following admission before authorization is required.

46. Question: Will DBH retain all contracting/network management responsibility with inpatient facilities, with the contractor functioning purely as a delegated UM/concurrent review vendor? Is there any expectation that the contractor use its own contracted hospital network? Additionally, how will admission notifications (including OON facilities and members with another County of Responsibility) reach the contractor directly from hospitals, through DBH, or both?

Answer: The contractor will retain all contracting/network management responsibilities with facilities; there is no expectation for the Contractor to use their own contracted network.

The hospitals will reach out to the contractor directly.

47. Question: Does DBH expect the contractor to provide 24/7/365 clinical coverage for a real time concurrent review (including nights/weekends/holidays), or will defined business hours be acceptable as long as the two-day response standard is met? If 24/7 coverage is expected, what are the minimum after-hours staffing expectations (e.g., RN or CNS availability, physician availability, escalation protocols)?

Answer: Yes, DBH expects the Contractor to provide 24/7/365 clinical coverage and the minimum staffing expectations is determined by the Contractor.

48. Question: Can the county please provide any available, updated historic utilization data (preferably through 2025) and projections?

Answer: Yes. The County can provide available historic utilization data (through 2025) and projections upon request. See Question No. 12 for expected projections per fiscal year.

49. Question: Do continued stay reviews ("for all Medi-Cal and indigent members") include precertification reviews?

Answer: Continued stay reviews are not included in the precertification reviews.

50. Question: Please confirm that concurrent review will be administered only for inpatient admissions (100%).

Answer: Yes, concurrent review will be administered only for psychiatric inpatient admissions.

51. Question: Do the anticipated review volumes include backlogged reviews? What is the current status, volume, and aging, and what are the major contributors to backlogging?

Answer: Yes, the anticipated review volumes include backlogged cases. The Contractor is expected to conduct concurrent and retrospective reviews for psychiatric inpatient admissions at out-of-county hospitals as part of this scope of work.

52. Question: What is the current and anticipated out-of-county volume?

Answer: The out-of-county volume is approximately one hundred (100) to two hundred (200) per month.

53. Question: Can we include notations on the pricing sheet (Attachment I) or should these be limited to the narrative responses only?

Answer: Attachment I is a sample; proposers may submit expanded and more detailed Rate Proposals along with Attachment J to reflect anticipated fees and/or costs.

54. Question: Will bidders be paid annually for the proposed services as estimated in the table or will there be a different payment methodology?

Answer: Contractor shall bill the County monthly in arrears for services provided by Contractor. All claims submitted shall clearly reflect all required information specified regarding the services for which claims are made. Contractor shall accept all payments from County via electronic funds transfer (EFT) directly deposited into the Contractor’s designated checking or other bank account.

55. Question: Does the County expect volume increases Years 2 and 3 of the contract, which is reflected in the estimated Year 2 and 3 annual fees?

Answer: Yes, the County expects volume increases Years 2 and 3 of the contract.

56. Question: If bidders exceed the 15% indirect expense cap, will their proposal be disqualified from consideration?

Answer: Proposals will not be disqualified from this consideration.

57. Question: Please list any Quality Improvement responsibilities of the vendor not specified in the RFP.

Answer: At this time, there are no additional Quality Improvement responsibilities for the vendor beyond those specified in the RFP. Any unforeseen Quality Improvement needs that arise would be addressed in accordance with the terms and limitations outlined in the contract.

58. Question: What is the anticipated award date?

Answer: The final authority to award a contract as a result of this RFP rests solely with San Bernardino County Board of Supervisors, or as delegated by the Board of Supervisors. If a vendor is awarded the contract, the contract will be tentatively presented to the Board of Supervisors on May 19, 2026 with a tentative contract start date of July 1, 2026.