SLCo SHE130921-1 Medicaid 1115 Waiver - RFC

Salt Lake County Contracts and Procurement, on behalf of the Salt Lake County Sheriff's Office Jail Health Services Division, is requesting proposals for Medicaid claim submission and management services under the 1115 Medicaid Waiver, with bids due July 29, 2026 at 1:00 p.m. Mountain Time. A virtual pre-bid conference was held July 15 at 9:00 a.m.

Vendors must demonstrate a minimum of three years' experience submitting Medicaid-eligible claims and provide two professional references. All employees with access to medical records or inmate files require background checks through the Utah Bureau of Criminal Investigation (no older than 45 days); disqualifying convictions include violent felonies, sex offender registration, and felony or misdemeanor convictions involving violence, moral turpitude, weapons, or specified other crimes within the past five years. Vendors must be licensed and insured in Utah, maintain workers' compensation insurance, commercial general liability of $1,000,000 per occurrence with $2,000,000 aggregate, and commercial automobile liability of $1,000,000 per occurrence, with Salt Lake County named as additional insured.

The contractor will prepare, submit, and manage Medicaid claims for incarcerated individuals who received Medicaid-covered services or medications during their final 90 days of incarceration. Initial implementation focuses on approximately 90 Medication-Assisted Treatment (MAT) participants, with eventual expansion to all inmates receiving Medicaid-eligible medical care. The contractor must integrate with the County's Saphire Health EHR system, comply with County IT standards and security policies, provide staff training on identifying and validating Medicaid-eligible claims, designate a dedicated Account Manager with additional billing specialists as needed, submit monthly reports on claim submissions and reimbursements, attend quarterly performance review meetings, and provide an annual compliance audit summary. Performance benchmarks include submission of 95 percent of clean claims within five business days, 100 percent initial follow-up on unpaid claims within 30 calendar days, and denial resolution averaging 30 calendar days or less.

The estimated annual cost is $10,000 for information purposes only without guaranteed minimum or maximum purchase quantities. The contract term is six years from execution. Pricing must be submitted as a percentage of final amounts received for settled claims; award goes to the lowest responsive, responsible bidder. Salt Lake County may qualify vendors for up to one point added to proposal score for each of two preference categories: Employee Health Care Preference (maintaining health benefits for covered employees and dependents) and Veterans and Companywide Hiring Preference (active veteran recruitment program, current veteran employment, drug and alcohol testing policy, recognized job training program, and OSHA-compliant safety program). Vendors must submit a completed Preference Certification Form with required supporting documentation at proposal submission to be considered for any preference.