Utilization Review

The Montana Department of Public Health and Human Services (DPHHS) has issued Request for Proposal DPHHS-RFP-2020-0238R seeking a contractor to provide comprehensive utilization management and review (UR) services for Montana Healthcare Programs. The procurement seeks a Quality Improvement Organization (QIO) or QIO-like organization to perform critical healthcare oversight functions, including level of care determinations, PASRR activities, functional assessments, prior authorizations, continued stay reviews, and special case reviews. All services must be conducted in strict compliance with federal and state regulatory requirements. The RFP was posted on June 28, 2019, with proposals due by August 30, 2019, at 2:00 PM MDT. Evaluation will be conducted using a points-based system, with 250 possible points allocated to cost, utilizing a comparative formula that awards points based on the lowest responsive offer. Potential bidders must submit detailed documentation including company information, qualifications, and a completed cost proposal template. The state reserves the right to negotiate contract terms with the highest-scoring offeror and may address non-material exceptions during the contract negotiation phase.

The RFP requires potential bidders to upload a QIO or QIO-like certification, acknowledge an Equal Pay for Women attachment, and complete a Dark Money Declaration form. While specific set-aside designations are not explicitly detailed in the provided documentation, the procurement appears open to qualified organizations meeting the specified requirements. No incumbent vendor information was provided in the available documents. The RFP does not specify a precise budget range or maximum award value, though the comprehensive nature of the requested services suggests a significant contract scope. Interested organizations must carefully review all requirements, particularly the technical qualifications related to utilization review processes and compliance with healthcare regulatory standards. Prospective bidders should pay close attention to the submission requirements, ensuring all documentation is complete and meets the specified criteria to be considered for the contract.