SW-30280 - USA (Maine) - Comprehensive Evaluation and Development of City Care Rate Setting System - Deadline January 31,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: SW-30280

Government authority located in Maine; USA based organization looking for expert vendor for comprehensive evaluation and development of city care rate setting system.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide current rates and rate-setting methodologies for city care provider reimbursement, and for the development of a plan to rationalize and streamline the current system, including a comprehensive assessment of rates for all city care covered services.
- The Department’s Office of Maine Care Services (OMS) administers the Maine Care program. A primary responsibility of OMS is to process Maine Care Provider claims and ensure appropriate payment for services rendered. OMS is also responsible for managing a Maine Care member-services function, which supports Maine Care Members in understanding their benefits and accessing service.
- Provide a comprehensive evaluation of Maine Care’s rates and rate setting system in comparison to other rates and payment models employed nationally for Medicaid, Medicare, and other payers;
- Design a workplan for the creation of a comprehensive, streamlined and coherent system, including a plan for the development of rates for specific services and programs.
A. Evaluate Existing Maine Care Reimbursement Rates and Payment Models: -
1. Catalogs and categorize existing Maine Care Payment Methods.
i. Catalogs and categorize the Payment Methods (e.g. cost reimbursement, cost settlement, Fee for Service (FFS) by identified unit, Per Member Per Month (PMPM), bundled payments for episodes of care, type of Alternative Payment Methods (APMs)) used by Maine Care for current Maine Care Benefits Manual (MBM) services 2. Benchmark reimbursement rates and Payment Methods for Maine Care Services: - a.    Benchmark existing Maine Care rates and payment models for every service covered under each section of the MBM, with the exception of Section 80 Pharmacy Services, to other state Medicaid, Medicare and commercial rates and payment models for comparable services
i. Payment Methods utilized by a minimum of five (5) peer state Medicaid plans that reimburse under a managed FFS system (i.e. non-Managed Care Organization), to be identified by the awarded Bidder and approved by the Department, for each comparable service;
ii. Medicare Payment Methods for comparable services; and
iii. Commercial health insurance plan Payment Methods for comparable services in the State, where available.
3. Recommend candidates for alternative payment models: - Identify Maine Care services that may be appropriate candidates for the development of APMs and provide rationale for these recommendations
B. Develop a Plan for a Comprehensive Rate Assessment Process: - Consideration of surveys of best practices from other state Medicaid programs
- Provide estimates for necessary Department investment: - Provide an estimate of the investment needed to conduct and implement the short- and longer-term rate reviews
- Report cataloguing and benchmarking Maine Care payment rates and methods with other states Medicaid rates, Medicare rates, and private insurance rates and recommending candidates for APMs.
- For more information you can download documents.
(2) All question must be submitted no later than January 15, 2020.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Friday, 31 January, 2020

Question Answer Deadline : Wednesday, 15 January, 2020

Category : Software, System and Application, Billing Services, Medical Billing and Coding

Country : USA

State : Maine

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