(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

are resolved, whichever happens last. In addition, the documentation may be subject to
review by the State Auditor’s Office;
RAC shall begin assigned work within 30 days of entering into the contract, or on October
1, 2012, whichever occurs last. Once a task or audit is assigned, HHSC and the RAC will
discuss and agree upon a reasonable date, based on the complexity of audit type and
audit work required to complete audit planning, fieldwork, appeals activities, and issue a
draft report to HHSC. The draft report shall include identification of improper payments, or
fraudulent activity, causes, and recommendations. It is the responsibility of the RAC to
communicate any potential improper payments or fraudulent activity to the provider prior to
the draft audit report in an effort to resolve any discrepancies or misunderstandings. The
RAC shall give providers sufficient time to address any identified improper payments or
fraudulent activity, including a reasonable time to respond and resolve any errors noted by
the RAC. Any funds recovered by HHSC for overpayments or underpayments actually
paid to providers by the state after each agreed upon audit completion date will be
excluded from the contingency and/or fixed fee calculation and payment;
HHSC may adopt rules regarding certain exemptions to the recovery audit and fraudrelated
audit process. RAC shall adhere to those rules; and
RAC shall perform all recovery audit(s) and fraud-related audit services and all services
reasonably related to such recovery audit and fraud-related audit services. RAC shall
provide all the recovery audit(s) and fraud-related audit services in compliance with all
requirements of this RFP and the contract. RAC shall perform the recovery audit(s) and
fraud-related audit services consistent with HHSC’s guidelines, directives, and rules, which
may be passed and as amended in the future. RAC shall comply with such current
guidelines and rules and any such amended guidelines and rules throughout the term of
the contract. All required recovery audit(s) and fraud-related audit services must be
provided at a highly competitive fee level, (i.e., the fee quoted should be the best value to
HHSC when all evaluation criteria are considered). HHSC reserves the right, in its sole
discretion, to enter into preliminary negotiations with more than one of the top
respondents.
These new responsibilities will require a significant investment of time and resources to plan for
and successfully execute.
While the federal government initiated these changes and will provide regulatory guidance to
states, it is state government that will ultimately be responsible for implementing and managing
requirements of the Affordable Care Act (ACA) at the local level.
1.7 Strategic Elements
1.7.1 Contract Type and Term
HHSC will award one contingency and fixed fee rate contract for this project that meet all scope
of work requirements outlined in this document (RAC services will be on a contingency basis
and all other services will be fixed fee based on negotiated scope of work). The initial term of
the contract is expected to be about September 1, 2012, through August 31, 2015. HHSC shall
have the option, in its sole discretion, to extend the contract for up to three additional one (1)
year periods, one (1) year at a time.
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