Utilization Review (UR)

The State of Montana's State Procurement Services Division is soliciting proposals on behalf of the Department of Health and Human Services (DPHHS) for utilization management and review services for the Montana Healthcare Program, with proposals due December 8, 2026 at 2:00 p.m. MST. The selected contractor must maintain Quality Improvement Organization (QIO) or QIO-Like status throughout the contract period.

Scope covers level of care determination, Preadmission Screening and Resident Review (PASRR) activities, functional assessments, prior authorizations, continued stay reviews, eligibility determinations, and special case reviews, performed in accordance with federal and state regulations and policies. Pricing is a single lump sum line item. Offerors must comply with all 20 buyer attachments (Attachments A through T) covering program requirements, service level agreements, performance measures, and technology specifications.

Because the contract involves federal funds, the awardee must obtain a Unique Entity ID from SAM.GOV and complete Federal Form NDA889. Offerors must comply with Montana prevailing wage requirements and maintain specified insurance coverage. Requested exceptions are subject to state approval by the contract exception deadline. Offerors must also certify nondiscrimination against firearm entities.

Proposals require a Business Information document, Scope of Work response, Offeror Qualifications document, and Budget Worksheet. Confidential or proprietary content requires a Trade Secret Affidavit and redacted copies. Offerors must disclose any artificial intelligence used in proposal development, and all AI-generated content requires validation by a named human subject-matter expert. Payment terms are Net 30 days from invoice with no discount for early payment. The RFP opened October 21, 2026.