PROCUREMENT- MD DEPT OF HEALTH & MENTAL HYGIENE--MAY 4

Maryland Department of Health & Mental Hygiene

Request for Proposals

Utilization Control of Selected Hospital, Long Term Care and Community Services Reimbursed by the Maryland Medicaid Program

SOLICITATION NO. OPASS 10-10387

RFP Issue Date: Thursday, April 22, 2010



RFP Issuing Office: Maryland Department of Health and Mental Hygiene

Office of Health Service

Division of Long Term Care Services



Summary Statement:

The Office of Health Services, a component of the Maryland Department of Health and Mental Hygiene (DHMH) is issuing this Request for Proposals to contract with a Utilization Control Agent (Contractor) to perform the services referenced in Section 3.2.5 of the attached RFP. The selected Contractor shall successfully deliver and be charged with the responsibility of conducting utilization control to ensure that:



a. Medical services are authorized only when medically necessary;

b. Medical services provided in a hospital on an inpatient basis are authorized only when such services cannot be effectively provided on an outpatient basis or more effectively and efficiently in a facility of a different type;

c. Medical services provided in a nursing facility, chronic hospital or in a community-based program are authorized only when an individual is appropriately determined to be medically eligible for those services;

d. Medical services provided to Medicaid recipients meet professionally recognized standards of quality;

e. All authorized medical services are provided in an effective and efficient manner; and

f. Abuses of utilization or payment are identified and reported to the Department.





Procurement Officer: Sharon Gambrill, CPPB

Deputy Director-Procurement

Office of Procurement and Support Services

201 W. Preston Street, Room 416

Office Phone: (410) 767-5816

Fax: (410) 333-5958

e-mail: gambrills@dhmh.state.md.us



Proposals are to be sent to: Maryland Department of Health and Mental Hygiene

Office of Health Services

201 West Preston Street, Room 221

Baltimore, MD 21201

Attention: Sabrina Lewis

Procurement Coordinator



Pre-Proposal Conference: Tuesday, May 4, 2010 1:00 PM Local Time

300 West Preston Street, Auditorium

Baltimore, Maryland 21201



Closing Date and Time: Friday, May 21, 2010 – 3:00 PM Local Time

SEE ATTACHED RFP FOR ADDITIONAL INFORMATION.