Final_CRFQ_0513_FLC2700000001_1_WV_CRFQ_FORM.PDF
PDF 743 KB Posted
- Attached to
- INFORMAL DISPUTE RESOLUTION PROCESS
- Solicitation number
- CRFQ 0513 FLC2700000001 1
- Issued by
- Kanawha County, West Virginia
About this file
This is a Centralized Request for Quote (CRFQ) form issued by the West Virginia Department of Administration Purchasing Division on behalf of the Office of the Inspector General (OIG), Office of Health Facility Licensure and Certification (OHFLAC). The solicitation seeks an open-end contract to conduct informal dispute resolution processes for healthcare facilities. The scope of work encompasses ten distinct line items covering dispute resolution reviews across multiple severity levels and deficiency categories, including Level 1 Long-Term Care reviews (10 units), Level 2 Long-Term Care reviews (10 units), Level 2 Substandard Care reviews (10 units), Level 3 Long-Term Care reviews (15 units), Immediate Jeopardy reviews (10 units), Condition Level Deficiency reviews (15 units), Standard Level Deficiency reviews without penalties (40 units), Standard Level Deficiency reviews with penalties (20 units), additional telephonic review fees (30 units), and additional face-to-face review fees (10 units). The question deadline is October 5, 2026 at 10:00 AM ET, with solicitation closing on October 15, 2026 at 1:30 PM. Bids should be submitted to the Department of Administration Purchasing Division, 2019 Washington Street East, Charleston, WV 25305, with inquiries directed to buyer Crystal G Hustead at (304) 558-2402 or crystal.g.hustead@wv.gov.
The CRFQ does not specify unit prices or total contract amounts, indicating that pricing will be established through the competitive bidding process. Invoicing and shipping are directed to OHFLAC at 1900 Kanawha Boulevard East, Suite 825, Building 6, Suite 817, Charleston, WV. All vendors are required to provide their Federal Employer Identification Number (FEIN) and principal contact information. The extended descriptions note that face-to-face and telephonic review fees are in addition to base review costs, with travel expenses and separate facility agreements to be assumed by requesting facilities. All offers are subject to terms and conditions contained in the complete solicitation documents.
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Other files
| File | Type | Posted |
|---|---|---|
| PLEASE READ-INSTRUCTIONS TO VENDORS.pdf | ||
| CRFQ FLC2700000001_Complete Solicitation Documents.pdf |
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Text version
Date Printed: Sep 28, 2026 Page: 1 FORM ID: WV-PRC-CRFQ-002 2020/05
Department of Administration Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130
State of West Virginia Centralized Request for Quote
Service - Misc
Proc Folder: 2072354 Reason for Modification:
Doc Description: INFORMAL DISPUTE RESOLUTION PROCESS
Proc Type: Central Master Agreement
Date Issued Solicitation Closes Solicitation No Version
2026-09-28 2026-10-15 13:30 CRFQ 0513 FLC2700000001 1
BID RECEIVING LOCATION
BID CLERK
DEPARTMENT OF ADMINISTRATION
PURCHASING DIVISION
2019 WASHINGTON ST E
CHARLESTON WV 25305
US
VENDOR
Vendor Customer Code:
Vendor Name :
Address :
Street :
City :
State : Country : Zip :
Principal Contact :
Vendor Contact Phone: Extension:
FOR INFORMATION CONTACT THE BUYER
Crystal G Hustead
(304) 558-2402 crystal.g.hustead@wv.gov
Vendor Signature X FEIN# DATE
All offers subject to all terms and conditions contained in this solicitation
Date Printed: Sep 28, 2026 Page: 2 FORM ID: WV-PRC-CRFQ-002 2020/05
ADDITIONAL INFORMATION
THE STATE OF WEST VIRGINIA PURCHASING DIVISION FOR THE AGENCY, WEST VIRGINIA OFFICE OF THE INSPECTOR GENERAL (OIG), OFFICE OF HEALTH FACILITY LICENSURE AND CERTIFICATION (OHFLAC), IS SOLICITING BIDS TO OBTAIN AN OPEN-END CONTRACT TO CONDUCT AN INFORMAL DISPUTE RESOLUTION PROCESS PER THE ATTACHED
DOCUMENTS.
***QUESTIONS REGARDING THE SOLICITATION MUST BE SUBMITTED IN WRITING TO CRYSTAL.G.HUSTEAD@WV.GOV PRIOR TO THE QUESTION PERIOD DEADLINE CONTAINED IN THE INSTRUCTIONS TO VENDORS SUBMITTING BIDS***
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 1 Informal dispute resolution review -LVL1 LTC 10.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Additional fee for face to face review, versus desk and/or telephone review, per deficiency. Additional fees for face to face will be assumed by requesting facility. The independent Review Organization shall enter a separate agreement with the facility. Note: All travel costs must be assumed by the requesting facility.
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 2 Informal Dispute Resolution review-LVL 2 LTC 10.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for long-term care facilities cited at Severity Level II or potential for more than minimal harm, but no actual harm, substandard quality of care, or immediate jeopardy, as defined by CMS.
Date Printed: Sep 28, 2026 Page: 3 FORM ID: WV-PRC-CRFQ-002 2020/05
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 3 Informal Dispute Resolution review-LVL 2 Sub.
Care
10.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for long-term care facilities cited at Severity Level II with a finding of substandard quality of care, as defined by CMS.
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 4 Informal Dispute Resolution review-LVL 3 LTC 15.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for long-term care facilities cited at Severity Level III or actual harm, as defined by CMS .
Date Printed: Sep 28, 2026 Page: 4 FORM ID: WV-PRC-CRFQ-002 2020/05
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 5 Informal dispute resolution review-Immediate
Jeopardy
10.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for ALL facilities cited as IMMEDIATE JEOPARDY, as defined by CMS or State Regulations for programs regulated by OHFLAC.
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 6 Informal Dispute Resolution review -Condition
LVL Deficiency
15.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for a Condition Level Deficiency as defined by CMS. (Not an Immediate Jeopardy)
Date Printed: Sep 28, 2026 Page: 5 FORM ID: WV-PRC-CRFQ-002 2020/05
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 7 Informal dispute resolution review -Not Invoking
Penalties
40.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for a Standard Level Deficiency as defined by CMS or State Regulations for programs regulated by OHFLAC and not invoking state penalties.
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 8 Informal Dispute Resolution review-Invoking
Penalties
20.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Informal Dispute Resolution review for a Standard Level as defined State Regulations for programs regulated by OHFLAC and invoking state penalties
Date Printed: Sep 28, 2026 Page: 6 FORM ID: WV-PRC-CRFQ-002 2020/05
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 9 Additional fee for telephonic review 30.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Additional fee for telephonic review, versus desk review, per deficiency. Note: All travel costs must be assumed by the requesting facility.
INVOICE TO SHIP TO
OHFLAC OFFICE OF INSPECTOR
GENERAL
1900 KANAWHA BLVD E 1900 KANAWHA BLVD EAST
SUITE 825 BLDG 6, SUITE 817
CHARLESTON WV CHARLESTON WV
US US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 10 Additional fee for face to face review 10.00000 EA
Comm Code Manufacturer Specification Model #
80122001
Extended Description:
Additional fee for face to face review, versus desk and/or telephone review, per deficiency. Additional fees for face to face will be assumed by requesting facility. The independent Review Organization shall enter a separate agreement with the facility. Note: All travel costs must be assumed by the requesting facility.
SCHEDULE OF EVENTS
Line Event Event Date
1 QUESTION DEADLINE: 10:00 AM ET 2026-10-05
Document Phase Document Description Page
FLC2700000001 Final INFORMAL DISPUTE
RESOLUTION PROCESS
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