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

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1. General Information 1.1. Scope The Texas Health and Human Services Commission’s (HHSC) mission in this Request for Proposals (RFP) is to award a qualified firm (hereinafter referred to as Recovery Audit Contractor (RAC)) to conduct improper payment recovery audit services for payments made by the State of Texas (State) to its Medicaid-enrolled providers for services provided under the Medicaid State Plan or a waiver of the Medicaid State Plan, and other audit services related to fraud investigations as determined by the State. The State of Texas, by and through the Texas Health and Human Services Commission (HHSC), seeks to award a contract to a qualified Recovery Audit Contractor firm to conduct audit services for the purpose of identifying overpayments and underpayments (hereinafter referred to as “improper payments”) made by the State of Texas to its providers in accordance with the specifications contained in this Request for Proposals (“RFP”). The selected RAC will identify improper payments made by the Texas Medicaid Program to its Medicaid-enrolled providers for provider types as determined by HHSC. Qualified RAC are to present the State with a proposal for: Detection of Medicaid improper payments Validation of Medicaid improper payments Tracking and reporting of Medicaid improper payments Coordination with HHSC in obtaining approval of recoupment/repayment of identified improper payments, to include providing all supporting documentation obtained by the RAC from Medicaid providers necessary for HHSC to conduct appeals. Additionally, HHSC seeks to award a contract to a RAC to perform recovery projects or other initiatives related to fraud investigations and program integrity efforts as assigned by HHSC, whether identified solely by HHSC, or as recommended by the RAC. The contract(s) resulting from this RFP will be primarily for RAC services paid on a contingency fee basis, but the contract will additionally provide for other audit services related to fraud investigations and program integrity efforts paid on a fixed fee basis. The Fixed Fees will be based on individual Fixed Fee Rates included in the Contract and the level of effort to perform a specific audit, audit services related to fraud investigations or any other service provided by the RAC that would not be appropriate to utilize a contingency fee to compensate the RAC for those specific services rendered. The Fixed Fees for these services will be based on the explicit fixed hourly rates proposed by the respondent and the projected number of hours to be worked on the specific audit or specific project by the respondent’s staff or the staff of the respondent’s subcontractor. The fixed fee will be proposed by the Contractor prior to the start of activities for fraud investigations and other services assigned by HHSC, subject to negotiation and acceptance by HHSC. The selected RAC must be capable of producing timely services and deliverables of sufficient quality to achieve HHSC results. The scope of this contract is subject to change and may require amending upon release of any future amendments to the final federal rules (42 CFR §§455.500-455.518) that may further 4
define the requirements of Section 6411 of the Patient Protection and Affordable Care Act (ACA), Expansion of the Recovery Audit Contractor (RAC) Program. 1.2. HHSC Point of Contact The sole point of contact for inquiries concerning this RFP is: Richard Blincoe Enterprise Contracts and Procurement Services (ECPS) Department 4405 North Lamar Boulevard, Building 1 Mail Code: 2020 Austin, Texas 78756 512-206-5468 Fax (512) 206-5552 richard.blincoe@hhsc.state.tx.us All communications relating to this RFP must be directed to the HHSC contact person named above. All communications between respondents and other HHSC staff members concerning this RFP are strictly prohibited. Failure to comply with these requirements may result in proposal disqualification. 1.3. Procurement Schedule The following table depicts the critical pre-award events for the procurement. All dates are subject to change at HHSC’s discretion. Procurement Schedule RFP Release Date June 11, 2012 RAC Vendor Conference June 22, 2012 RAC Vendor Questions Due June 25, 2012 HHSC Posts Responses to RAC Vendor Questions June 29, 2012 RAC Proposals Due July 9, 2012 Deadline for Proposal Withdrawal July 9, 2012 Tentative Award Announcement August 1, 2012 Anticipated Contract Start Date September 1, 2012 Initial report on Potential Recoveries to State for review Approximately 3-4 months after contract start date (or TBD) 1.4. Mission Statement The Texas Health and Human Services Commission’s (HHSC) mission in this Request for Proposals (RFP) is to award a qualified RAC to conduct improper payment recovery audit services for payments made by the State of Texas (State) to its Medicaid-enrolled providers for services provided under the Medicaid State Plan or a waiver of the Medicaid State Plan based on a contingency fee, as well as fixed fees for other audit services related to fraud investigations and program integrity efforts as determined by the HHSC. 5
Page 1 and 2: Tom Suehs, Executive Commissioner R
Page 3: 4.3 Statewide Annual HUB Utilizatio
Page 7 and 8: Coordination with HHSC in obtaining
Page 9 and 10: due diligence in its efforts to ide
Page 11 and 12: are resolved, whichever happens las
Page 13 and 14: 1.8.2 Conflicts of Interest A confl
Page 15 and 16: 1.13 Protest Procedures Texas Admin
Page 17 and 18: e. Establish a Governance process w
Page 19 and 20: . Notify providers in writing of po
Page 21 and 22: timeline will include reasonable an
Page 23 and 24: . Provide monthly status reports to
Page 25 and 26: 2.6 Location of Services The RAC wi
Page 27 and 28: Respondents must notify HHSC of any
Page 29 and 30: identify trade secret or confidenti
Page 31 and 32: 3.15.1 Part I - Business Proposal T
Page 33 and 34: work as a prime contractor or subco
Page 35 and 36: 3.15.4.6 Section 6 - Proposed Appro
Page 37 and 38: Respondents must base their Cost Pr
Page 39 and 40: 3.15.30 Proposed Compensation Table
Page 41 and 42: 4. Historically Underutilized Busin
Page 43 and 44: 4.6.1 Identify Subcontracting Areas
Page 45 and 46: 4.6.7 Written Justification of the
Page 47 and 48: 5. Proposal Evaluation HHSC will us
Page 49 and 50: after HHSC receives payment from th
Page 51 and 52: the overpayments recovered or the u
Page 53: (7) Statistician (8) Other Professi

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

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