Montana eMacs #DPHHS-RFP-2027-0712AB

Montana Healthcare Program Utilization Management and Review Services

Montana is seeking a contractor to provide utilization management and review services for its Medicaid program. - Government buyer: State of Montana, State Procurement Services Division (SPSD), on behalf of the Department of Health and Human Services (DPHHS); services support the Montana Healthcare Program (MHP). - Services requested: Utilization management and review, including level-of-care determinations, Preadmission Screening and Resident Review (PASRR), functional assessments, prior authorizations, continued-stay reviews, eligibility determinations, and special-case reviews. - Key requirement: The contractor must maintain QIO or QIO-Like status throughout the contract period and comply with applicable federal and state requirements. - OEMs and vendors: No OEMs or vendors are named in the materials. - Products and quantities: No products, part numbers, or quantities are specified.

Description

The State of Montana, State Procurement Services Division, on behalf of the Department of Health and Human Services, is seeking proposals for utilization management and review services for the Montana Healthcare Program. Services include level of care determinations, PASRR activities, functional assessments, prior authorizations, continued stay reviews, eligibility determinations, and special case reviews. The organization must maintain QIO or QIO-Like status throughout the contract period and perform the work in accordance with applicable federal and state rules, regulations, policies, and procedures.

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