California eProcure #SD25-00019

CDCR/CCHCS Health Care Provider Network and Prior Authorization Services Solicitation

The California Department of Corrections and Rehabilitation (CDCR), through California Correctional Health Care Services (CCHCS), is seeking proposals for a Health Care Provider Network and Prior Authorization Services contract. - Government Buyer: - California Department of Corrections and Rehabilitation (CDCR) - California Correctional Health Care Services (CCHCS) - Direct Care Contracts Section - Scope of Services: - Establish a Health Care Provider Network (HCPN) to deliver community-based specialty medical services for approximately 90,000 incarcerated individuals across 30 institutions and 13 Reentry Program (REPS) facilities - Services include hospital care, specialty physician services, ambulatory surgery, medical transportation, dental specialty, skilled nursing, medicated assisted treatment, telehealth, laboratory, and pathology - Contractor must use the CDCR/CCHCS-designated Third Party Administrator (TPA) for claims processing - Potential requirement to implement an electronic prior authorization system after the first contract year - Unique/Notable Requirements: - Compliance with HIPAA and information security standards - Extensive technical requirements for order processing and microbiology result handling via HL7 messaging - Performance guarantees and mandatory qualifications - Contractor must integrate with TPA and may be required to develop electronic prior authorization capabilities - No specific OEMs or commercial vendors are named, as this is a service-based solicitation - Contract term is up to five years, with five optional one-year extensions, subject to performance and funding

Description

The California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CDCR/CCHCS) is soliciting proposals from qualified entities to provide a Health Care Provider Network of community-based specialty medical services providers for CDCR/CCHCS. The contract term is up to five years, anticipated to begin on December 1, 2026, and end on November 30, 2031, with an option to extend for up to five additional one-year terms through November 30, 2036. Contract extensions are subject to satisfactory performance, funding availability, and CDCR/CCHCS discretion.

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