Utilization Management Criteria

Added: Oct 12, 2017 4:18 pm











The Department of Veteran Affairs (VA) Strategic Acquisition Center (SAC) intends to negotiate with McKesson Technologies, LLC, on a sole source basis pursuant to VAAR 873.104(d) and FAR 6.302-1(a)(2) wherein the supplies or services required by the agency are available from only one responsible source , to provide valid and reliable utilization review criteria for use in assessing appropriateness of medical services.



VHA is committed to a healthcare system that treats its patient population effectively, efficiently, and appropriately. This means being responsible for the efficient use of resources and ensuring that each veteran receives consistently reliable, high-quality care in the optimal setting along the health care continuum at appropriate care delivery intervals. The current focus of the VHA Utilization Management (UM) Program is inpatient care with plans to expand the review capability to outpatient care and care in the community.



UM is a key component of VHA s Quality Management System and can be defined as the process of reviewing care prospectively, concurrently, and retrospectively to determine the appropriateness, medical necessity of, and efficiency of clinical care services across the health care continuum.



McKesson Technologies, LLC will provide valid and reliable utilization review criteria for use in assessing appropriateness of medical services. McKesson Technologies, LLC will provide licensing source for unlimited use, updates, and clinical/technical support for Utilization Management (UM) evidence-based criteria and associated tools in electronic format.



The required products will include:

InterQual® Level of Care Criteria: Acute Adult and Behavioral Health

InterQual® Care Planning Criteria

CareEnhance® Review Manager Enterprise (CERMe)

InterQual® View

InterQual® Mobile

InterQual® Anonymous

InterRater® Reliability (IRR) Suite



The license agreement shall include all product support such as application/software updates, patches, upgrades, report generation, and help desk response to resolve clinical and technical issues. Updates to the electronic version of the criteria or associated applications including clinical revisions, technical enhancements, system patches, and version upgrades shall be included in the license agreement.

The Contractor shall ensure all electronic criteria application changes are compatible with the current Veterans Affairs National Utilization Management Integration (NUMI) and are coordinated at least 60 business days in advance of implementation.



The North American Industry Classification System (NAICS) number is 519190. This notice is NOT a request for competitive proposals. Parties may identify their interest, accompanied by supporting capability statement to this office no later than October 19, 2017 at 4:00pm EST. Email response to clifford.snipe@va.gov; reference 36C10G18R0052 Utilization Management Criteria in the subject line.



Costs associated with preparation, submission, and follow-up information requests are the offeror s responsibility. The Government will not reimburse for any associated costs. Telephone responses will not be accepted. The determination to conduct a competitive procurement based on responses to this notice is solely the Contracting Officer s discretion. If no responses are received, the Government will proceed with the sole source procurement.