Request for Proposals DYS Managed Medical Care

RFP IHHA 2026000150

3/6/2026 Basic Information and Timeline

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All dates and times are subject to change and are in Mountain Time.

Table of Contents

A. Quick Resources

1. For questions about this solicitation, contact the Single Point of Contact identified above.

2. For help with Vendor Self Service (ColoradoVSS), contact the Vendor Self Service Help Desk vsshelp@state.co.us or 303-866-6464.

3. For information about doing business with the state of Colorado generally, go to: https://osc.colorado.gov/spco/accesscolorado.

4. The Department is always interested in improving. Please take this survey at any time: https://docs.google.com/forms/d/e/1FAIpQLScIgv9lgrT3x5AGzcvT1xkvpucrRhhN5QJ23vLcbyfvc2smaw/viewform (We do actually read the responses)

B. Introduction and Background Our Vision: Achieving youth success and safer Colorado communities.

Our Mission: To protect, restore and improve public safety by utilizing a continuum of care that provides effective supervision, promotes accountability to victims and communities, and helps youth lead constructive lives through positive youth development.

The Division of Youth Services (DYS) provides for the care and supervision of youth committed by the District Court to the custody of CDHS. DYS operates 12 secure youth centers that serve youth between the ages of 10-21 who are pre-adjudicated or committed. In addition to residential programming, DYS administers juvenile parole services throughout Colorado, and the Colorado Youth Detention Continuum, including when DYS has physical custody of youth in a secure facility. Youth may be committed to the DYS if they are adjudicated for crimes committed prior to their 18th birthday and may remain under the DYS jurisdiction until age 21. DYS provides supervision, residential treatment, and community-based parole aftercare services to committed youth until their parole is complete. This Request for Proposal (RFP) is specific to both the detained and commitment populations in secure residential care. The process includes but is not limited to detention medical and behavioral health services and assessment at the time of commitment, placement(s) in a state secure facility, transitional or step-down programs that are less restrictive, and non-residential community-based parole services. Youth transitions are initiated through successful completion of goals on their individual treatment plans based on the assessment completed at the time of commitment and ongoing throughout their time in the DYS. The assessments include, but are not limited to, a Validated Risk and Needs Assessment, University of California, Los Angeles Post-Traumatic Stress Disorder Reaction Index-Revised (UCLA PTSD RI-5), Juvenile Automated Substance Abuse Evaluation (JASAE), Precursors to Change, Colorado High Risk Victimization tool (Screen for Human Trafficking), Security Level Determination Matrix, Brain Injury Screen and other psychological and/or neuropsychological screening and evaluation as indicated. Once the statutorily mandated assessment process is complete, the Multi-Disciplinary Team makes recommendations for goals in treatment. The DYS’s Data Management and Analysis Unit provides detailed information about the DYS populations and trends. This information is available at the following web address: https://www.colorado.gov/pacific/cdhs/publications-reports

DYS’s Provision of Medical Services A comprehensive medical services delivery system exists to meet the integrated health care needs of youth, including, but not limited to medical, behavioral health, psychological, neuropsychological, psychiatric, and dental needs of youth in secure residential placement. Health services within the DYS system consist of both an internal primary care network and an external specialty network of providers and services. Each state-owned and operated youth services center has a primary care medical clinic staffed with a combination of medical, behavioral health, psychiatric, and dental providers. The function and capacity of these clinics is to triage, diagnose, treat and manage medical, psychiatric evaluation, support, and medication management needs, and dental illness and injury as well as to identify and refer for the provision of 1) external specialty care and services, including ancillary, laboratory and dental beyond the scope of care that can be provided within a youth services center, and 2) hospital services, including emergency, inpatient and outpatient.

Within the DYS internal primary care network system, the appointed Medical Authority (Responsible Physicians and Psychiatric Medical Director), DYS Associate Director (Behavioral Health & Medical Services), DYS Director of Medical Operations, DYS Director of Behavioral Health Operations, DYS Medical Operations Coordinator, and the DYS Dental Authority serve as clinical gatekeepers in the access of external specialty and hospital services by supporting clinics and partnering with the DYS Medical Authority to ensure the Medical Authority has all clinical information available to make sound clinical decisions. In addition, at the CDHS office level, a Medical Director serves as the responsible authority to ensure the provision of health services. The external specialty network of providers and services also includes a provision for pharmacy services. A centralized Behavioral Health & Medical Services unit provides statewide administrative oversight of the DYS health services in collaboration with the CDHS office level Medical Director.

C. How to Submit a Proposal

1. In General. Email the proposal, Signature Page, and any other required documents in one zip file as an attachment to this email address: JG_2026.t0daevju5fo2kuxp@u.box.com Please be aware of email server file size limitations. The maximum file size the Department can accept is 15 GB.

2. Only Attachments. Only the zip file goes through. The Department cannot see any text or messages sent to the email address identified above. Written questions may be emailed to the Single Point of Contact.

3. File Names. The zip file name should start with the solicitation type, solicitation number, and vendor name (e.g., “RFP 2026000150 Vendor Name…”). Vendors may include additional information in the zip file name.

4. Timing. The zip file typically uploads within five minutes; however, vendors should submit zip files at least thirty minutes prior to any deadline to ensure the file is received.

5. Confirmation. Vendors will receive an email confirmation from box.com that the zip file was uploaded correctly. If not, please contact the Single Point of Contact.

6. No Encryption. Do not encrypt emails sent to the submission email as it may prevent full submission.

7. Pre-bid Conference. There will not be a pre-bid conference.

8. Questions. Vendors may submit questions by email to the Single Point of Contact prior to the Questions Due Date identified in the Basic Information and Timeline above. The Department may answer some, all, or none of the questions asked by posting them publicly.

9. Late Proposals will not be accepted unless specifically allowed by rule and at the Department’s sole discretion.

D. Proposal Format

1. Maximum Length. Proposals should not exceed 65 pages. The Department may evaluate proposals negatively if this page limit is not followed.

Page formatting should include clear headers to align with the requirements of the proposal and pagination (e.g., Page __of __, etc.).

2. Business Proposal. Indicate in detail the scope of services included in your proposal based on the criteria listed below. Clearly identify any criteria required by the State that are not included in your proposal, if any.

Please provide information in response to the following criteria. Each response should outline the method by which the Offeror will provide the necessary services to meet the medical managed care needs for CDHS-DYS.

E. Proposal Content

1. Business Proposal. Indicate in detail the scope of services included in your proposal based on the criteria listed below. Clearly identify any criteria required by the State that are not included in your proposal, if any. Please note: if any requested services or items are not included in your proposal, it may not be considered for award.

Criteria: Information on Claims adjudication and payment system.

Please provide information for network specialty medical care providers. This includes the ability to receive claims, and the ability to transmit funds to and from DYS.

Criteria: Company Overview and Relevant Business Experience: DYS is seeking an offeror who has significant experience and subject matter expertise, and the capacity to successfully complete the tasks described below. The State expects that the awarded vendor will continue to make the key project personnel available through the life of the contract. The state reserves the right to approve any replacement personnel.

Describe how your company will provide managed medical care for DYS. Indicate key personnel who will be assigned to the project and describe their experience.

Explain how you will ensure that equally qualified people are assigned to the project if assigned individuals leave the project.

Describe your firm’s experience with similar projects. Submit at least THREE (3) client references for each project for a maximum of THREE (3) projects within the past FIVE (5) years.

Criteria: Overall Fiscal Management. The final contract will contain reimbursement provisions for actual monthly expenditures; the awarded vendor must be able to manage cash flow issues that arise.

Describe your accounting and record keeping systems, fiscal safeguards, and accountability procedures that will be utilized to fiscally manage the managed medical services for DYS separate from any other projects the Offeror may service.

Compliance with Accounting Requirements for Contractors: Finance & Accounting Requirements for Independent Contractors are attached as DYS Exhibit A. All contractors must agree to comply with all of these fiscal requirements. In your proposal discuss your company's ability to comply with all of the finance and accounting requirements.

Criteria: Utilization Management (UM). DYS recognizes that the use of nationally accepted criteria as the basis for utilization management decisions and processes will be advantageous regarding managing costs and minimizing potential liability to the State, for both inpatient and outpatient medical care. The intent of DYS medical services is to link treatment to conditions that, if not treated, are reasonably expected to deteriorate prior to release from a correctional facility. In general, the awarded vendor and the Colorado Division of Youth Services intend to work to direct a range of care for medically necessary services within these parameters In your proposal, outline your process of Utilization Management and related criteria.

Criteria: Covered Health Care Services. The fact that a participating provider may prescribe, order, recommend or approve a service or supply does not, in and of itself, make the service or supply a covered benefit. Criteria for covered and non-covered services should be in place.

In your proposal, outline the method of establishing covered services and evaluating the appropriate level and place of service for requested medical care services. Note: Due to the statutory mandate that DYS provides for all healthcare needs to detained and committed youth, DYS reserves the right to approve excluded medical services for payment based on individual circumstances of its eligible and non-eligible youths (e.g., youth on parole) and may administratively override the policies of the Offeror if DYS determines the need.

Information: Physician Services. Primary care is provided under the direction of the Medical Authority to effectively evaluate and treat the healthcare needs of the youths, including consultation and direct service as needed, and on-call services by the appointed Medical Authority for detained and committed youth. Such activities may include, but are not limited to physical examination, medical treatment(s), specialty care referrals, surgical services referrals, and dietary counseling for medical conditions.

Covered preventive services should include:

· initial screening;

· routine immunizations;

· mandatory testing for general health welfare;

· periodic physical assessment based on age, sex, general health status and known risk factors and other chronic health conditions.

Criteria: DYS requires a minimum of one Physician to serve as the Medical Authority. Proposals should include the ability to provide consultation, collaboration, and continuing education to medical clinic staff.

Include in your proposal the model of delivering medical authority oversight for medical services and providers.

Criteria: DYS requires a model of physician services to include on-site physician services once per week for each youth services center, and delivery and/or oversight of the following:

Primary care services provided by physicians, Provision for the following services should be included in the proposal:

· External ancillary services

· External specialty care and services,

· Inpatient Hospital services,

· Outpatient Hospital services,

· External Dental services,

· Pharmacy services,

· Physician services,

· Psychiatry services,

· Services related to Quality Assurance and Oversight & Continuous Quality Management

· Physician (primary care) on-call services – Physician on call evenings (5pm-8am), weekends, and holidays for emergency call back within 15 minutes for youth. Physician on call Monday-Friday 8am-5pm for non-emergency call back by COB for the Medical Clinic Staff. This includes call-back for both physical health and psychiatric services.

· Physician (psychiatry) on-call services – Physician on call evenings (5pm-8am), weekends, and holidays for emergency call back within 15 minutes for youth. centers. Physician on call Monday-Friday 8am-5pm for non-emergency call back by COB for the Medical Clinic Staff. This includes call-back for both physical health and psychiatric services.

· Nursing services for coverage of vacancies, including RN and APP services.

· Utilization review services.

· Comprehensive continuous quality management program, including near miss and adverse event reviews on a monthly or as needed basis.

· Referral network for specialized medical health care, optometric, audiometric and dental (oral surgery) health care from specialists and outside institutions.

· Optometric, audiometric, mobile x-ray, physical therapy, and occupational therapy services provided on-site via contract.

· Data reporting infrastructure.

· Data storage platform that allows for archived reports to always be accessible.

Criteria: DYS requires a specialty care network. Covered services include consultation with a specialty care provider (SCP) whose opinion or advice is requested by the youths’ DYS physician, APP, Nurse, or Medical Authority for further evaluation of an illness or injury. Services are performed either on an inpatient or outpatient basis and may include examination, diagnostics, therapeutic treatment or surgery and telemedicine. In your proposal, please include:

Diagnostic Services. Covered services should include:

· Laboratory Diagnostic Services: (i.e., includes diagnostic, clinical and anatomic pathological laboratory services and materials);

· Radiological and Non-Radiological Diagnostic Imaging Services: includes radiography, fluoroscopy, mammography, and ultrasounds;

· Imaging Services: includes nuclear medicine, computerized axial tomography (CAT), positron emission tomography (PET), cardiac ultrasonography, magnetic resonance imaging (MRI), cardiac catheterization, and arthrography;

· Complex Vascular Diagnostic Services: includes holter monitoring, treadmill or stress testing, and impedance venous arteriography;

· Complex Neurological Diagnostic Services: includes electroencephalogram (EEG) or electromylogram (EMG) and evoked potential;

· Complex Pulmonary Diagnostic Services: includes pulmonary function testing and apnea monitoring;

· Complex Allergy Diagnostic Services: includes allergy skin tests;

· Otologic Services: includes evaluations to determine the need for medical or surgical treatment of hearing deficit or a related medical problem Therapeutic Services. Covered services should include:

· Chemotherapy Services: includes oral and injectable medication when medically appropriate;

· Therapeutic Radiology Services: utilized for the treatment of cancer and other diseases;

· Complex Vascular Therapeutic Services: includes percutaneous transluminal angioplasty;

· Hemodialysis and Peritoneal Renal Dialysis Intervention: includes education and medically necessary supplies;

· Rehabilitation Services, Speech, Physical and Occupational Therapy: therapies are subject to review for significant improvement within two (2) months of onset of therapy. All services require an approved treatment plan and are subject to re- evaluation at any time. In the case of physical therapy, the goal is to instruct the patient to perform a self-monitored therapeutic exercise program, e.g., post-operative orthopedic case.

Inpatient/Outpatient Hospital Services. Covered services should include the accommodation, services and supplies as ordered by a member’s physician during an admission to a hospital for acute or intensive care. An admission on any given day includes one of the following room accommodations:

· medical, surgical or critical care units (e.g., ICU), including bed, board and both general and special nursing care;

· private rooms are excluded unless medically necessary required for security reasons, the hospital does not have a semi-private room available, or the hospital furnishes private rooms as the principal room accommodation for its patients.

· operating, recovery and treatment rooms, and equipment (inpatient only);

· labor/delivery rooms and equipment (inpatient only);

· anesthesia material and its administration (inpatient only);

· diagnostic services and supplies required to diagnose illness, injury or other conditions;

· therapeutic services and supplies required to diagnose illness, injury or other conditions;

· medications approved by the Food and Drug Administration (FDA);

· dressings, splints, casts, and other supplies for medical treatment by facility;

· oxygen and its administration;

· non-replaced blood, blood plasma, blood derivatives, and their administration and processing;

· intravenous injections and solutions.

The following services and supplies are examples of benefits that are not covered:

· vocational rehabilitation services (outpatient only);

· private duty nursing services, unless approved by the Medical Authority or Clinical Support Services and the DYS Director of Medical Operations;

· personal convenience items;

· medications and supplies for the member’s use after discharge past 30 days;

· medications that have been approved by the FDA for experimental or investigational use, unless approved by Contractor’s Clinical Support Services;

· occupational therapy unless deemed necessary by the Medical Authority.

Emergency Services (do not require prior authorization). Covered services should include:

· emergency room related charges and physician services;

· ambulance services, including ambulance transport to the nearest appropriate hospital when any other form of transportation is not appropriate and when the ambulance service is provided in conjunction with emergency medical care;

· detoxification screenings and medical detoxification services for DYS youth when medically necessary.

Surgical Services. Covered services include surgical services that are performed by a PCP or SCP and are generally recognized and accepted procedures for diagnostic or therapeutic purposes in the treatment of an illness or injury. The location of service must be appropriate to the complexity of the surgery involved. These sites include the physician’s office, emergency room, inpatient and outpatient hospital and ambulatory surgery center. Services should include:

· physician services—includes a surgical assistant when medically necessary and when performed by an assistant surgeon in connection with a surgical procedure;

· anesthesia services—when medically necessary to administer anesthetics and when performed by a qualified professional to achieve general or regional anesthesia, related resuscitative procedures and pre-operative and post-operative visits.

· Operative procedures.

i. suture of wounds;

ii. debridement of wounds, burns or infections;

iii. use of a needle or cannula for biopsy, aspiration or injection;

iv. intravenous, arterial or cardiac catheterization;

v. electrical, chemical or medical destruction of tissue;

vi. reconstructive plastic surgery in order to maintain or prevent loss of function (mastectomy reconstruction is excluded).

· Miscellaneous Procedures.

i. reduction of fractures or dislocations;

ii. orthopedic castings;

iii. endoscopic examination of internal organs of the body.

Oral surgical services are limited to treating the following medical conditions: accidental injury to sound, natural teeth, jawbones or surrounding tissues; correction of a non-dental, pathophysiological condition that has resulted in a severe functional impairment; or treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, tongue, roof and floor of mouth. Removal of impacted wisdom teeth and root canals are covered. Oral Surgeries do not include treatment for temporomandibular joint disorder (TMJ).

Services not covered by the benefit plan include:

· acupuncture;

· hypnosis;

· administration of general anesthesia by the primary surgeon or the assistant surgeon;

· dental services or dental surgery, except as deemed necessary by the DYS Dental Authority, including, but not limited to, accidental injury to sound, natural teeth, jawbones or surrounding tissues; the correction of a non-dental, pathophysiological condition that has resulted in a severe functional impairment; or treatment for tumors and cysts requiring pathological examination of the jaws, cheeks, lips, tongue, roof and floor of the mouth.

Pregnancy, Maternity and Newborn Services. Covered services should include:

· prenatal services;

· delivery and related postpartum care;

· juvenile members’ newborns are immediately covered by a designated caregiver or the Department of Social Services.

Services not covered by the program:

procedures intended solely for determining the biological sex assigned of the fetus;

non-therapeutic sterilizations;

non-therapeutic abortions.

Pharmacy Plan. Covered medications must be covered and means medications approved by the FDA, or medications issued for off label use when clinically justified. Covered services must include medications requested by a patient’s physician or advanced practice provider and subject to approval by the DYS Medical Authority. Provision of a medication formulary is required. Exceptions may be approved by the appointed Medical Authority, the Director of Medical Operations and/or Coordinator, or their designee prior to dispensing. Prior Authorization Requests (PARs) for non- formulary psychotropic medications are approved by the contractor psychiatrist.

The program should not include:

· personal care items;

· I.V. equipment dispensed without the I.V. solutions;

· spirituous liquors of any kind;

· dietary needs or food supplements unless prior authorized according to specified guidelines;

· hypodermic needles, syringes or similar devices (except for the administration of medication prescribed by a physician);

· medications classified by FDA as “investigational” or “experimental.”

Prosthetic Devices. Covered Prosthetic devices should include:

· cardiac pacemakers;

· colostomy bags (and other ostomy bags) and necessary equipment required for attachment, including irrigation and flushing equipment and other items/supplies related to ostomy care;

· terminal devices, e.g., hand, leg or artificial eyes when used as non-cosmetic spacers;

· hearing aids.

Prosthetic devices not covered by the program include:

devices in connection with TMJ to increase vertical dimensions or to restore occlusion, unless approved;

medical devices that have not been approved for marketing by the FDA or approved for coverage by Medicaid.

· Durable Medical Equipment. Covered devices should include:

· rental or purchase of DME;

· repair, maintenance and delivery services;

· disposable supplies essential to approved care;

· custom orthotics (inserts) for comfort (elimination of pain).

DME should meet the following criteria:

· can stand repeated use and is used to serve a medical purpose;

· is not useful to a person in the absence of an illness or injury;

· is appropriate for use in the home or workplace.

DME items not covered by the program:

· air purifiers;

· air conditioning;

· barbells or other physical fitness equipment;

· bed boards;

· cages (knee);

· corsets, L-S;

· diathermy machine;

· disposable artificial larynx (permanent device preferred);

· extra mattresses unless medically indicated;

· neck halter & c-collar;

· over door traction kit;

· comfort or convenience items;

· convenience items for persons caring for a member (i.e., stairways, elevators and cushion life chairs).

Oxygen Equipment. Oxygen supplies should be covered by the program for members with significant hypoxemia who meet the medically necessary criteria, including laboratory evidence and health conditions. Oxygen contractors are the usual and customary benefit for youths who qualify.

· Skilled Extended Care Facilities. Youths may be admitted to an extended care facility with skilled nursing services as an alternative to hospitalization. Covered services should include:

· semi-private (multi-bed unit) room accommodations, i.e., bed, board and general nursing care;

· diagnostic services and supplies required to diagnose illness, injury or other conditions;

· therapeutic services and supplies required to diagnose illness, injury or other conditions;

· medications approved by the FDA;

· dressings, splints, casts and other supplies for medical treatment provided by the nursing facility;

· oxygen and its administration;

· non-replaced blood, blood plasma, blood derivatives and their administration;

· intravenous injections and solutions;

· special dietary needs and food supplements;

· physical therapy.

Services and supplies not covered by the program:

· private duty nursing services unless medically necessary;

· personal convenience or hygiene items;

· medications and supplies for the patient's use after discharge from the skilled extended care facility;

· medications that have been approved by the FDA for experimental or investigational use.

· Vision. Covered services for DYS members should include:

· periodic routine eye examinations;

· refractions;

· prescription glasses* - lenses and frames are provided as needed; however, tints or special treatment are not covered unless the condition meets medically necessary criteria.

· Supplies and services not covered by the program:

· contact lenses and related supplies, unless medically necessary;

· radial/laser keratotomy, PRK and other surgical procedures for sole purpose of improving vision for cosmetic reasons;

· special treatment of prescription eyeglasses that are not medically required for health and safety.

Hearing Services. Covered services should include:

· examination to determine need for hearing correction;

· bilateral hearing aids for cases that meet medical criteria for DYS members.

Cochlear implants are not covered by the program.

Dental Services. The DYS Dental Authority provides oversight of all dental services.

· Covered services that do not require prior authorization from the awarded vendor:

i. initial exam within fourteen (14) days of incarceration;

ii. amalgams and composite restorations (fillings);

iii. cleanings deemed necessary by treating dentist;

iv. bite guards when necessary for DYS youth.

· Covered Services for DYS youth requiring prior authorization from the award vendor:

i. services exceeding one hundred dollars ($100) in cost;

ii. X-Rays;

iii. root canal treatment on anterior bicuspid and first molar teeth that are restorable with composite of amalgam;

iv. necessary extractions;

v. transitional partials.

General Exclusions. These items include any service that is:

· not in the current schedule of covered services, unless approved by DYS

· medically unnecessary care according to medical standards of care;

· performed while not incarcerated by DYS;

· only for the convenience of the youths.

· all medical care and services rendered without obtaining authorization as required by the Offeror’s Utilization Management Program;

· sexual dysfunction or inadequacy;

· personal comfort or convenience items, including tennis shoes, geo-mattresses (egg- crate;

· services of chiropractors;

· cosmetic surgery or implants;

· experimental or investigational treatment, procedures or devices as determined by the Medical Authority;

· holistic or homeopathic care, including medications and ecological or environmental medicine;

· fertility testing;

· paternity testing.

Psychiatric Services. Psychiatric services are provided via subcontract of the Offeror and must include a Psychiatric Medical Director who oversees the care provided to the youth in the physical and legal custody of the Division of Youth Services, and a proposed model of care that includes a sufficient number of board certified child & adolescent psychiatrists to serve the DYS population in secure care.

Criteria: Authorizations and Utilization Management. In your proposal, please describe and justify:

what utilization management criteria will be used, and the referral and prior authorization process that will be used. The offeror should fully explain in its proposal how it intends to accomplish referrals and authorizations statewide.

Information for Reference Only: Description of the Referral/Authorization Processes

1. (Non-emergency) referrals for outside specialty medical care are made by the Agency PCP. Whether by telephone contact or other technology, the PCP must be able to readily communicate their referral to the Offeror, including any subsequent dialogue as necessary for the Offeror to make a determination of whether it is appropriate to authorize or to deny the referral.

2. The Offeror informs the PCP of authorization or denial of the referral. (The Offeror's proposal should fully explain the specific policies, procedures, and time frame for making this determination.)

3. If the referral is approved and the outside specialty medical care provider is available locally within the Offeror's established service provider network, the Offeror should direct the authorization to said provider and automatically notify said provider of the authorization. The Offeror is expected to encourage the use of its provider care network.

4. The Offeror should also be able to promptly confirm any authorizations which are not directed to specific providers within its service provider network, as needed.

5. The Offeror notifies a designated agency contact of all authorizations, preferably on a daily Monday - Friday basis, and provides relevant information thereto. The Offeror should have a method of "flagging" any/all authorizations for outside specialty medical care not directed to a specific provider within the Offeror's established service provider network. The Offeror will establish a discounted reimbursement rate for providers not in the service provider network.

6. DYS will not be responsible for authorizations issued for non-eligible parties.

7. DYS reserves the right to conduct a secondary review of any/all authorizations and to deny or override such authorizations, as DYS deems to be appropriate. The Offeror will notify its PCP of any denials or overrides resulting from the review process.

8. DYS reserves the right to direct or redirect any authorizations for outside specialty medical care to or from the Offeror's provider network, for logistics or other reasons.

9. DYS expects a referral/authorization/notification process that is readily accessible and user-friendly.

10. DYS medical providers refer all authorizations to the scheduling person at their youth services center. Due to security and logistical concerns regarding the transport of youths, the youth services centers will be responsible for scheduling all services/appointments.

Criteria: Utilization Review and Continuous Quality Management Services. DYS expects the awarded vendor to conduct inpatient concurrent reviews as well as retrospective review as part of its Utilization Management (UM) services. In addition, DYS expects prospective, concurrent, and retrospective drug utilization review (DUR) to also be included in the awarded vendor’s Utilization Management services. In your proposal, describe how you will:

Provide utilization management services to DYS patients; understanding that such services may or may not be discontinued once a patient is admitted as an inpatient or if the Agency is no longer fiscally responsible for medical care for the patient.

Conduct inpatient concurrent reviews to include hospitalized patients on observation or inpatient status, as well as retrospective reviews. The timeline for concurrent reviews shall be the first business day and every day thereafter the UM Nurse will conduct visitation and provide the Agency a verbal update. This may include reviews on patients for whom the Agency is not fiscally responsible.

Obtain records and provide oral and written reports to assist DYS in conducting its own concurrent reviews as needed.

DYS reserves the right to conduct its own concurrent reviews and make scheduling and discharge decisions accordingly under the directive of the CDHS office level Medical Authority.

Utilize the national accepted criteria as the basis for utilization management decisions.

Provide one (1) FTE assigned to the Division of Youth Services in full for continuous quality management program functions, including but not limited to:

· Policies and Procedures used for authorizations, prior authorizations, claims administration, and utilization review services.

· Technology considerations.

· Eligibility verification system.

· How review findings will be reported.

· DYS expects a psychiatrist to review current psychiatric practices, provide supervision to any psychiatric nurse practitioners, develop and maintain a medication formulary (including a prior authorization review process), participate in emergency and involuntary medications reviews, on-call services, polypharmacy reviews, and assist with all required meetings to review quality of care and clinical reviews system for consulting with treating psychiatrists as needed by DYS. DYS also expects the position for continuous quality management to be hired at the RN level of qualification and overseen by a physician.

Criteria: Service Provider Network Contract Management. DYS expects that the awarded vendor will have an established service provider network that can provide medical care to youth populations located throughout the State. The awarded vendor will show willingness to continue work with current DYS service providers who have proven to be successful partners in the provision of quality care.

Please describe how you will contractually manage and maintain a specialty provider network, including:

· Lowering costs through the Offeror's negotiated/contractual cost agreements for medical care;

· Complete coverage of all or most needed types of medical care services and specialties. (A list of in-network providers and hospitals should be included with the proposal.)

· Geographically accessible specialty medical care providers and institutions throughout all or most of the State, in order to minimize logistic considerations for the agencies;

· Proposed use of existing providers and proposed credentialing process of providers. Certain outside specialty medical care that can be provided more economically through on-site “clinics.”

Note: DYS would like the Offeror to include Sands Dental Clinic, an off-site dental clinic in the specialty network as a preferred provider;

· Provide and maintain pharmacy provider(s) capable of serving youth in DYS youth services centers statewide. The management of prescriptions and pharmaceuticals will be included, and a competitive pricing strategy will be left to the discretion of the offeror. Provide a cost estimate with proposal

· The Offeror should describe the agreement with these participating pharmacy provider(s) and shall include negotiated pricing arrangements to optimize cost discounts while assuring adequate access.

Scope Note: The awarded vendor must contract with participating pharmacy provider(s) who will guarantee on-site delivery of medication to the facility originating the prescription within 48 hours of placing the order, and stat orders as needed to be filled within four hours. Additional services include pharmacy reviews quarterly by a licensed pharmacist, and monthly clinical reviews of chronic diseases and psychiatric care as outlined by DYS;

· Provide in writing the Offeror’s credentialing process and timelines for adding new providers to its network. Additionally, the Offeror will notify the Agency of providers in the service network who have lost credentials or privileges Criteria: Administrative and Reporting Services: DYS expects a full range of administrative and reporting services to be provided by the medical care management cont. The awarded vendor must be capable of making claims determinations, timely filing decisions, claims reviews, and appeals, in accordance with the Offeror's Policies and Procedures (P & P), weekly and monthly funding requests, and conducting audits of paid claims at a minimum of every 6 months to ensure that claims to providers were paid accurately according to the terms of the provider contract.

Please discuss hours of operation, prompt authorization or denial of referrals, prompt payment to providers, claims adjudication, standardized reporting and ad hoc reports. Sample of reports should be included in the response. The offeror should demonstrate the ability to develop a set of financial and clinically based performance reporting that would serve to identify areas for improvement throughout the contractual term.

In addition, describe how you will provide DYS with a standardized reporting package, including but not limited to:

· Monthly profiles of individual DYS youth centers, including referrals and utilization.

· Monthly cost projections of all medical care and pharmacy costs that have been authorized by the Offeror but for which funds have not yet been requested by the Offeror (IBNR analysis) due by the 5th of each month reporting.

· Monthly cost projections applied to the appropriation.

· Monthly data analysis and report on trends and make recommendations to lower costs.

· Other specific reporting, as may be requested by the Agency or other state entities, to be provided with short timelines. The Offeror should demonstrate the ability to produce ad hoc reports within 24 – 72 hours of said request, unless otherwise negotiated between the Offeror and the Agency.

· A monthly cumulative summary report of medical expenditures. A final year-end report is due to the Agency no later than October 1 following the close of the

· State’s fiscal year.

· For the purpose of reporting trend analysis and comparisons to previous years, the Agency expects the new Offeror to utilize historical and clinical data as is available from the current Offeror.

Criteria. Contracting. The successful Offeror must be willing to enter into a contract with the State of Colorado, Division of Youth Services.

Please reference Exhibit E- (Sample) State of Colorado Contract, and acknowledge you are able to accept the terms and conditions set forth by the State of Colorado.

Criteria. Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) Disclosure:

The successful Offeror must acknowledge whether the company is a Covered Entity for HIPAA. If there is any uncertainty of the company’s status, please visit this website which will assist in making this determination: http://www.cms.gov/HIPAAGenInfo/06_AreYouaCoveredEntity.asp#TopOfPage Please reference Exhibit B – (Sample) State of Colorado HIPAA Business Associate Addendum

2. Cost. Please answer or address the following questions or issues:

1. Please complete and return Exhibit C: Budget with Justification Form

1. Pharmacy estimated cost reference on Pg. 20

F. Demographic Form

1. In an effort to best comply with Colorado Procurement Code rule R-24-103-901 re maximizing opportunities, we like to gather certain voluntary demographic information from potential vendors where possible. This is entirely voluntary and does not affect an organization’s application/proposal/quote/bid or contract whatsoever in any way. It is not taken into consideration in this procurement process or reviewed by evaluators in this process. The information gathered is submitted directly to a data gathering team at CDHS who provide general statistics on outcomes and trends to CDHS Contracts & Procurement leadership on approximately a quarterly basis so that this leadership can look for ways to generally and overall maximize opportunities as described in the Code. Please fill out the following form regarding your organization’s demographic information if and to whatever extent you are willing. This is again entirely voluntary and has no impact on your potential work for the State: https://app.smartsheet.com/b/form/219f6db8803b4994afb9bf70e84fa421 G. How Proposals are Evaluated

1. In General. The Department will identify the proposal(s) most advantageous to the State through an objective and competitive process. A committee will review all acceptable proposals and may request more information or clarifications from any vendor. The committee will then recommend one or more proposals for award. The Single Point of Contact will notify all vendors of the final decision.

2. Mandatory Criteria. The Department may identify mandatory criteria. However, the Department reserves the right to waive mandatory requirements pursuant to Rule 24-103-301-03.

3. Evaluation Factors. The Department may evaluate proposals based on the information requested or referenced in the proposal content section, or as noted throughout the solicitation.

4. References. The Department may contact references, whether provided or not, and also consider them as part of the evaluation.

H. Ethics and Accessibility

1. Any person involved in the purchasing process for the State, any end users of such goods and services, any vendor or contractor that does business with the State, and any other interested third parties to the procurement process shall enhance the proficiency and stature of the purchasing process by adhering to the highest standards of ethical behavior.

2. Accessibility Requirements. All work performed as a result of this solicitation must comply with all applicable provisions of §§24-85-101, et seq., C.R.S., and the Accessibility Standards for Individuals with a Disability, as established by the Office Of Information Technology pursuant to Section §24-85-103 (2.5), C.R.S. and 3) all State of Colorado technology standards related to technology accessibility and with Level AA of the most current version of the Web Content Accessibility Guidelines (WCAG), incorporated in the State of Colorado technology standards.

I. Administrative Information

1. Communication. All communication regarding this solicitation must be done through the Single Point of Contact identified above. Unauthorized contact with any Department personnel other than the Single Point of Contact regarding this solicitation is prohibited and may result in disqualification.

2. Notices. The Department may modify this solicitation by posting changes via the Colorado VSS website. All communications will be posted on the VSS, www.colorado.gov/vss , and/or through a direct email from the Single Point of Contact.

3. Modifications of Proposals. Proposals may be modified or withdrawn by the vendor prior to the established proposal due date and time.

4. Public Opening. On the date and time shown above, the Department will hold a public opening pursuant to Rule 24-103-201-13. Vendors may request an accommodation to attend the public opening from the Department.

5. Presentations or Site Visits. At the Department’s sole discretion, the Department may request presentations or site visits. Vendors should not, however, prepare the proposal with the assumption that an opportunity for oral presentations or revisions will be offered.

6. Acceptance of solicitation terms. A proposal submitted in response to this solicitation shall constitute a binding offer and acknowledgment that all terms and conditions of this solicitation are accepted. Vendors must identify any variations between its proposal and the solicitation. Failure to do so shall be deemed a waiver of any rights to subsequently modify the terms of performance.

7. Contract. Vendors must agree to the State’s contract terms, found here: https://cdhs.colorado.gov/procurement or as an exhibit to this solicitation. Please note that any referenced or attached model contract lists the State’s standard required legal provisions but may not include the specific scope of work and other specific terms or requirements for this solicitation. Vendors must review any attached contract terms and note any exceptions. If no exceptions are noted, Vendor is indicating an intent to accept the terms as-is. Modifications to the State’s contract terms constitute increased risk and costs to the State. Therefore, Vendor’s noted exceptions may be considered in any evaluation.

8. Award. The Department will notify all vendors who submitted a proposal when it issues a Notice of Intent to Award. The awarded vendor(s) must act in good faith to execute an agreement on or before the Anticipated Contract Start Date identified above. If this date is not met, through no fault of the State, the State, at its sole discretion, may cancel the Notice of Intent to Award.

9. Protests. Any actual or prospective vendor who is aggrieved in connection with the solicitation or award of a contract may protest to Lauren Ingalls (email to lauren.ingalls@state.co.us), Procurement Director, Division of Contracts and Procurement, Department of Human Services. The protest shall be submitted in writing within ten business days after such aggrieved person knows, or should have known, of the facts giving rise thereto.

10. CORE Registration. Unless otherwise noted, before the Department can award to any vendor, that vendor must be registered in CORE, which can be completed through Vendor Self Service at www.colorado.gov/vss.

11. EFT. Awarded vendors are encouraged to sign up for EFT transfers.

12. Secretary of State Registration. Before Contract execution, the awarded vendor must be registered to do business in the State of Colorado. If a vendor is a foreign corporation (formed under a statute or common law in a jurisdiction other than Colorado) or other foreign entity transacting business in the State of Colorado, it shall warrant that it currently has obtained and shall maintain any applicable certificate of authority to transact business in the State of Colorado and has designated a registered agent in Colorado to accept service of process.

13. System for Award Management. Before Contract execution, the awarded vendor(s) must be registered with the System for Award Management (SAM.gov).

14. Confidentiality. The State of Colorado is subject to the requirements of §24-72-200.1, C.R.S., et seq., Colorado Open Records Act. Anything submitted by a vendor is likely to become public information. Vendors may submit, as a part of their solicitation response, a written request for classification of certain portions of the proposal as confidential information pursuant to Colorado Procurement Code R-24-101-401-03. Material for which confidentiality has been requested shall be readily identifiable and separable from other portions of the solicitation to facilitate public inspection of the non-confidential portion of the solicitation response, if it is not, the confidentiality request will not be considered. Commingling of confidential and non-confidential information is not acceptable and any confidentiality request made in this fashion will not be considered. In no event shall an entire proposal be classified as confidential. Marking an entire proposal as confidential is a confidentiality request that will not be considered. Price information will not be considered confidential.