Medicaid Medical Frailty Determination Services

Colorado's Department of Health Care Policy and Financing is issuing an RFI for Medicaid Medical Frailty Determination Services, with responses due August 20, 2026 at 2:00 PM Mountain Time and inquiries due August 13, 2026. This is market research — no contract award results from this RFI.

The Department seeks vendor feedback on independent medical frailty determination capabilities for Medicaid members requesting exemptions from community engagement requirements under newly enacted federal law. The scope encompasses receiving referrals, reviewing medical and behavioral health documentation, conducting clinical reviews, making medical frailty determinations, documenting clinical rationale, and supporting appeals and quality assurance activities. Vendors must evaluate whether individuals' physical, mental, intellectual, developmental, substance use-related, or behavioral health conditions significantly impair their ability to comply with community engagement requirements by assessing multiple information sources including medical records, behavioral health records, functional assessments, Activities of Daily Living assessments, and disability determinations.

The Department anticipates an estimated annual referral volume of approximately 100,000 determinations, with workload expected to fluctuate. Service-level expectations include standard determinations within approximately 10 business days, expedited determinations within three business days, and incomplete referral notifications within two business days.

Vendors must address clinical operations, operational capacity, implementation approaches, and recommendations for service delivery models. Key operational considerations include referral intake processes, staffing models with clinical qualifications, quality assurance programs, technology integrations with eligibility systems, and reporting capabilities. No pricing information is required for this RFI. All responses become the property of the State and will be submitted through the Colorado Vendor Self Service website.