RFI B3Z-URPA
Page 1 of Amendment 001
STATE OF MISSOURI OFFICE OF ADMINISTRATION DIVISION OF PURCHASING AND MATERIALS MANAGEMENT (DPMM) REQUEST FOR INFORMATION (RFI)
AMENDMENT NO.: 001 RFI NO.: B3Z-URPA TITLE: Precertification and Concurrent Review Services ISSUE DATE: 10/27/08
REQ NO.: NR 886 25759004110 BUYER: Mary Call PHONE NO.: (573) 751-1695 E-MAIL: mary.call@oa.mo.gov
WRITTEN COMMENTS REQUESTED BY: 12/17/08 AT 2:00 PM CENTRAL TIME
RETURN COMMENTS TO: (U.S. Mail) MARY CALL, DPMM PO BOX 809 JEFFERSON CITY MO 65102-0809 (Courier Service) MARY CALL, DPMM 301 WEST HIGH STREET, RM 630 JEFFERSON CITY MO 65101-1517 (Electronic Mail) mary.call@oa.mo.gov
PROVIDE COMPANY INFORMATION BELOW:
DOING BUSINESS AS (DBA) NAME LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO.
MAILING ADDRESS
IRS FORM 1099 MAILING ADDRESS
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
CONTACT PERSON
EMAIL ADDRESS
PHONE NUMBER
FAX NUMBER
TAXPAYER ID NUMBER (TIN)
TAXPAYER ID (TIN) TYPE (CHECK ONE)
VENDOR NUMBER (IF KNOWN)
___ FEIN
VENDOR TAX FILING TYPE WITH IRS (CHECK ONE)
___ SSN
(NOTE: LLC IS NOT A VALID TAX FILING TYPE.)
___ Corporation
___ Individual
___ State/Local Government
___ Partnership
DATE
___ Sole Proprietor
___Other ________________
AUTHORIZED SIGNATURE
PRINTED NAME
TITLE
RFI B3Z-URPA
Page 2 of Amendment 001
Attachment 2 is hereby added to RFI B3Z-URPA in order to provide interested offerors a sampling of the reports currently provided by the entity under contract to perform Utilization Review Prior Approval Services under C305129001. Attachment 2 reflects the number of inpatient certifications performed for the 4th quarter and the entire contract period. It also reflects the different methods in which certification requests come in and the different types of certifications performed. Attachment 2 is a separate link to be downloaded from the Division of Purchasing and Materials Management’s internet website https://www.moolb.mo.gov for RFI B3Z-URPA.
RFI B3Z-URPA
Page 1 of 5, plus Attachment 1
STATE OF MISSOURI OFFICE OF ADMINISTRATION DIVISION OF PURCHASING AND MATERIALS MANAGEMENT (DPMM) REQUEST FOR INFORMATION (RFI)
RFI NO.: B3Z-URPA TITLE: Precertification and Concurrent Review Services ISSUE DATE: 10/27/08
REQ NO.: NR 886 25759004110 BUYER: Mary Call PHONE NO.: (573) 751-1695 E-MAIL: mary.call@oa.mo.gov
WRITTEN COMMENTS REQUESTED BY: 12/17/08 AT 2:00 PM CENTRAL TIME
RETURN COMMENTS TO: (U.S. Mail) MARY CALL, DPMM PO BOX 809 JEFFERSON CITY MO 65102-0809 (Courier Service) MARY CALL, DPMM 301 WEST HIGH STREET, RM 630 JEFFERSON CITY MO 65101-1517 (Electronic Mail) mary.call@oa.mo.gov
PROVIDE COMPANY INFORMATION BELOW:
DOING BUSINESS AS (DBA) NAME LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO.
MAILING ADDRESS
IRS FORM 1099 MAILING ADDRESS
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
CONTACT PERSON
EMAIL ADDRESS
PHONE NUMBER
FAX NUMBER
TAXPAYER ID NUMBER (TIN)
TAXPAYER ID (TIN) TYPE (CHECK ONE)
VENDOR NUMBER (IF KNOWN)
___ FEIN
VENDOR TAX FILING TYPE WITH IRS (CHECK ONE)
___ SSN
(NOTE: LLC IS NOT A VALID TAX FILING TYPE.)
___ Corporation
___ Individual
___ State/Local Government
___ Partnership
DATE
___ Sole Proprietor
___Other ________________
AUTHORIZED SIGNATURE
PRINTED NAME
TITLE
Matt Blunt
Governor
Larry W. Schepker
Commissioner
State of Missouri OFFICE OF ADMINISTRATION Division of Purchasing and Materials Management 301 West High Street, Room 630 Post Office Box 809 Jefferson City, Missouri 65102-0809 (573) 751-2387 Fax: (573) 526-9817 TTD: (800) 735-2966 Voice: (800) 735-2466 www.oa.mo.gov/purch
James Miluski
Director
TO: RE:
Precertification and Concurrent Review Service Providers: Request for Information, RFI B3Z-URPA Precertification and Concurrent Review Service for MO HealthNet
The State of Missouri, Division of Purchasing and Materials Management is planning to implement a competitive procurement process by issuing a Request for Proposal (RFP) for Precertification and Concurrent Review Services for the Missouri Department of Social Services, MO HealthNet Division. However, prior to development of the Request for Proposal (RFP) for this planned procurement process, the State of Missouri is seeking input from potential offerors via this Request for Information (RFI). Purpose: The purpose of this RFI is to allow the opportunity for qualified individuals and qualified organizations to provide the State of Missouri with ideas, suggestions, and other information relevant to acute and psychiatric inpatient hospitalization certifications, concurrent care, and case management services so that a new Request for Proposal can be developed. This RFI is for planning purposes only. It does not constitute a solicitation or Request for Proposal (RFP), nor does it restrict the Missouri State Government as to the ultimate acquisition approach. The State of Missouri does not intend to award a contract on the basis of this RFI or to otherwise pay for the information solicited. Any contract that might be awarded based on information received or derived from this RFI will be the outcome of the future competitive procurement process. Input Guidelines: Meetings - The State of Missouri would like to schedule meetings with organizations who are willing to provide input to the State. These meetings will be held by appointment, on a first come, first serve basis in Jefferson City, MO during the week of December 8, 2008. Please send an email to Mary Call at mary.call@oa.mo.gov, if you would like to schedule such a meeting. However, due to time and scheduling constraints, a maximum of six (6) such meetings with individual companies/organizations will be scheduled.
RFI B3Z-URPA
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Written Comments - If you are unable to schedule a personal meeting, but have input and suggestions for the MO HealthNet Division, the State of Missouri is still requesting your input and assistance with this endeavor through written comments. Such written comments should be submitted by no later than 2:00 p.m. Central Time on December 17, 2008 to Mary Call, Division of Purchasing and Materials Management, PO Box 809, Jefferson City, MO 65102-0809. Comments are encouraged to be submitted via email to mary.call@oa.mo.gov. Input is requested concerning one or more of the following: An innovative way to obtain certification of all hospitalizations or ability to provide a web based hotline, fax or mail system for physicians and hospitals to obtain the certification. Concurrent care and discharge monitoring options prior to the participant’s discharge from the hospital. Electronic health records that can be incorporated into MO HealthNet's CyberAccesssm web-based tool to be used internally for reporting and tracking purposes as well as allow the provider community to view records that may not have been readily accessible before. This should include an interface with the hospital community to obtain a discharge summary upon the participant's discharge from the hospital. The information exchange should be in real-time. Case management services after the participant has been discharged. A tracking and reporting tool using evidence based groups to assist in the participant's coordination of care, case management services and QIO reports. Plan for transitioning to a DRG payment system using ICD-10 diagnosis coding standards. Tracking and scoring provider and participant performance. Background: The MO HealthNet Division is a division within the Department of Social Services responsible for the administration of Missouri’s Medicaid Program called MO HealthNet. MO HealthNet provides health care access to low income individuals that are elderly, disabled, members of families with dependent children, low-income children, uninsured children, pregnant women, refugees, or children in state custody. Services are received through a fee-for–service or managed care delivery system. The MO HealthNet fee-for-service program serves participants not enrolled in MO HealthNet Managed Care, and provides some services not included in MO HealthNet Managed Care. Participants may freely choose which approved provider they go to for care under the FFS delivery system. Based on the recent passage of Senate Bill 577, the MO HealthNet Division is transforming the way in which it delivers and pays for health care services. The new, transformed program will focus on the establishment of health care homes, wellness, prevention, improved health outcomes, individual responsibility, evidence-based practice, technology and efficient program management. Efforts are
RFI B3Z-URPA
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already underway to establish this new focus, including implementation of Administrative Service Organizations (ASOs) to offer care management and coordination for fee for service participants. The MO HealthNet Division wishes to capture real time hospitalization data, including discharge summaries, to share with the ASOs for improved continuity of care. MO HealthNet Managed Care serves MO HealthNet Managed Care members in 54 counties of Missouri. MO HealthNet Managed Care members must select a MO HealthNet Managed Care health plan and a primary care provider (PCP) within the Managed Care health plan. Managed Care providers may refer the member to other providers based on care needed. Contract C305129001 - A current contract exists for Utilization Review/Prior Authorization (URPA) services. A copy of the contract can be viewed and printed from the Division of Purchasing and Materials Management’s Public Record Search and Retrieval System located on the Internet at: http://www.oa.mo.gov/purch. Please reference the contract number, C305129001, or the bid number, B3Z05129, when searching for the documents. In addition, a copy of the previous RFP, B3Z05129 is included herein by reference as Attachment 1 to RFI B3Z-URPA, and can be downloaded as a separate link from the Division of Purchasing and Materials Management’s internet website https://www.moolb.mo.gov, after clicking on the RFI bid number, B3Z-URPA. Information about the process used and procedures followed under C305129001 is summarized below: Currently, the MO HealthNet Division requires physicians and/or hospitals to certify most inpatient hospitalizations. Providers can do this via telephone, fax or mail. The Severity of Illness/Intensity of Service (SI/IS) criteria is used to determine medical necessity of the inpatient admission. The most recent versions of InterQual ISD Pediatric Acute Level of Care and Adult Acute Level of Care, Solucient's Length of Stay by Diagnosis and Operation, North Central and Psychiatric Length of Stay by Diagnosis, North Centeral are used to determine the appropriate length of stay. If the inpatient admission meets the SI/IS criteria for admission, the hospital provider is given a certification number to enter on their claim to receive a per diem payment. The certification, which includes the participant’s information, provider name and National Provider Identifier (NPI), authorized period and certification number, is entered into the Missouri Medicaid Management Information System (MMIS) to match up with the claim when it is received from the hospital provider. If extended hospitalization is indicated beyond the initial length of stay assigned, the hospital and/or attending physician can request a continued stay review. Providers are required to provide additional medical information to warrant the continued hospitalization as well as request the number of additional days needed. The MO HealthNet Division also requires quarterly retrospective validation samples to ensure the information provided during the certification process is substantiated by documentation and clinical findings in the medical record. On a monthly basis, post payment Certificate-of-Need (CON) reviews of psychiatric facilities are performed. Facilities designated by the state are monitored for compliance regarding the MO HealthNet Division's requirements for inpatient psychiatric services for individuals under age 21. On a monthly basis, post-payment reviews of specialty pediatric hospitals as defined in 13 CSR 70-15.010(2)(P) are performed as determined by the MO HealthNet Division.
RFI B3Z-URPA
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MO HealthNet uses a web-based tool called CyberAccesssm which allows physicians to prescribe electronically, view diagnosis data, receive alerts, select appropriate preferred medications, and electronically request drug and medical prior authorizations for their MO HealthNet participants. CyberAccesssm is the first step toward a comprehensive electronic health record for MO HealthNet participants. Closing: The State of Missouri looks forward to your input in this important information gathering process and sincerely appreciates your efforts in helping the state determine future directions for the procurement of Precertification and Concurrent Review Services. If you have any questions, please feel free to contact me at 573-751-1695 or via e-mail at mary.call@oa.mo.gov. Sincerely,
Mary Call
Missouri Division of Purchasing & Materials Management
phone: 573/751-1695 fax: 573/526-9817 email: mary.call@oa.mo.gov
RFI B3Z-URPA
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