Web Based Subscription Access for Evidence Guidelines

Status: Posted Contact Name: Ron Hurley Contact Number: 512-406-2598 Contact Email: Ron.Hurley@hhs.texas.gov Response Due Time: 10:30 AM Agency/Texas SmartBuy Member Number: 529 Days Solicited: 14+ Days for Entire Solicitation Package Solicitation Posting Date: 10/18/2023 Response Due Date: 11/6/2023 Last Modified: 10/18/2023 4:38 pm Solicitation Description: Executive Summary The Surveillance Utilization Review (SUR) department of the Office of Inspector General (OIG) of the Health and Human Services Commission (HHSC) is seeking to re-procure subscription access to a web-based evidence-based guidelines subscription service for use in performing retrospective utilization reviews of paid Medicaid inpatient hospital admissions. During reviews, OIG personnel assess the medical necessity for inpatient care; appropriateness of diagnosis, the medical record’s support for diagnoses, compliance with federal coding guidelines and

quality of care provided during the inpatient stay. OIG personnel must access and retrieve evidence-based guidelines to make determinations during review. HHSC Procurement and Contracting Services (PCS) will administer the procurement process for this Solicitation, which includes RFO solicitation publication, handling of communications from vendors, as well as managing the receipt of Solicitation Responses for review and evaluation. Scope of Work As required by Tex. Admin. Code, Title 1, Part 15, Chapter 371, Subchapter C, Section 371.204, HHSC OIG nurses evaluate the medical necessity of inpatient admissions by reviewing medical records associated with hospital submissions. Executive Summary The Surveillance Utilization Review (SUR) department of the Office of Inspector General (OIG) of the Health and Human Services Commission (HHSC) is seeking to re-procure subscription access to a web-based evidence-based guidelines subscription service for use in performing retrospective utilization reviews of paid Medicaid inpatient hospital admissions. During reviews, OIG personnel assess the medical necessity for inpatient care; appropriateness of diagnosis, the medical record’s support for diagnoses, compliance with federal coding guidelines and quality of care provided during the inpatient stay. OIG personnel must access and retrieve evidence-based guidelines to make determinations during review. HHSC Procurement and Contracting Services (PCS) will administer the procurement process for this Solicitation, which includes RFO solicitation publication, handling of communications from vendors, as well as managing the receipt of Solicitation Responses for review and evaluation. Scope of Work As required by Tex. Admin. Code, Title 1, Part 15, Chapter 371, Subchapter C, Section 371.204, HHSC OIG nurses evaluate the medical necessity of inpatient admissions by reviewing medical records associated with hospital submissions. OIG nurse reviewers conduct medical record reviews for both fee-for-service and managed care facilities. These facilities include acute care hospitals, children's hospitals and freestanding psychiatric and rehabilitation hospitals. These hospitals provide medical services for areas including, but not limited to, maternal deliveries, newborn care, pediatric treatments, surgical procedures, general medical treatments, rehabilitation and psychiatric services. OIG reviews hospital records that cover the following medical events: prior authorization, inpatient submission and outpatient services. Historically, OIG nurses conduct approximately 24,000 reviews per year. Contract Term The initial term of any Contract resulting from this Solicitation will be one (1) year. HHSC, at its sole option, may extend any Contract awarded pursuant to this Solicitation for up to four (4) optional one-year renewals. HUB Pre-Recorded Training For information on developing an HSP in good faith, the HHSC HUB Program offers a pre-recorded webinar at the following link: https://www.gotostage.com/channel/hhshubprogramtraining Schedule of Events URL: Addendum: Class/Item Code(s): 95635-*Internet Database Subscriptions