Utilization Review Software

The Indian Health Service, operating through Gallup Indian Medical Center, seeks a site-hosted, evidence-based clinical criteria software license and support services for hospital utilization review processes, with quote submissions due September 15 at 12:00 p.m. Mountain Time. The procurement is set aside for Indian Small Business Economic Enterprises under the Buy Indian Act, foreclosing competition outside that pool.

Place of performance is Gallup, New Mexico. The software must support a minimum of 12 simultaneous users and evaluate clinical criteria across nine key areas: observation services, inpatient admissions, continued inpatient stays, discharge planning evaluation, ambulatory surgical services appropriateness, transition of care to rehabilitation/subacute/skilled nursing services, substance use disorder transitions, durable medical equipment transitions, and retrospective risk management and quality care evaluation. The solution must comply with CMS Conditions of Participation (482.30), utilize evidence-based clinical criteria with source documentation, and incorporate current standards of care. Cloud-based solutions must hold current FedRAMP Certification; server-based solutions on government infrastructure are exempt from this requirement. The contractor shall not access or manage Protected Health Information or Personally Identifiable Information, must provide initial onsite training for a minimum of 12 IHS employees, deliver ongoing technical IT support, furnish length-of-stay applications and reports, and provide continuous software updates aligned with standard-of-care changes. The contract includes a one-year base period from October 1, 2026 through September 30, 2027, plus four one-year option periods extending through September 30, 2031. NAICS code is 513210, Software Publishers; PSC is 7A20, IT and Telecom—Application Development Software (Perpetual License Software). Evaluation weighs Technical Capability to meet government needs and Price. A Business Associate Agreement addressing HIPAA compliance is required; the contract incorporates FAR 52.212-4 and multiple federal clauses addressing privacy, security, accessibility (Section 508/WCAG 2.1 Level AA), sustainable products, and small business compliance.