HEALTH CARE FINANCING ADMINISTRATION OFFICE OF ACQUISITION AND GRANTS 6325 SECURITY BOULEVARD, BALTO., MD., 21207

99 -- SOURCES SOUGHT FOR UTILIZATION AND QUALITY CONTROL PEER REVIEW OR GANIZATIONS (PRO) CONTRACTS FOR DELAWARE, NEVADA, AND WYOMING SOL HCFA POC Contact, Kathleen Kelso, 410/966-7214/ Contracting Officer, Brian Hebbel, 410/966-5159. Out-of-State PRO contracts in Delaware, Nevada, and Wyoming will expire on March 31, 1996. The Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203) amended section 1153 of the Social Security Act (the Act) by adding a new subsection (i) that prohibits the Secretary from renewing the contract of any PRO that is not an in-State organization without first publishing a notice announcing when the contract will expire. The HCFA is seeking interested in-State organizations. An in-State organization is defined as an organization that has its primary place of business in the State in which review will be conducted (or that is owned by a parent corporation, the headquarters of which is located in that State). The PRO is responsible for reviewing certain health care services furnished under Title XVIII of the Social Security Act (the Act) and under certain other Federal programs to determine whether thoses services are reasonable, medically necessary, furnished in the appropriate setting, and are of a quality that meets professionally recognized standards. PRO activities are part of the Health Care Quality Improvement Program (HCQIP), a program which supports the mission of the HCFA to assure health care security for beneficiaries. The HCQIP is carried out locally by the PRO in each State. Each PRO is to focus on the development and implementation of cooperative projects as a method for the PRO to improve the quality of care in State. The organizations that are eligible to contract as PROs have satisfactorily demonstrated that they are either phsician-sponsored or physician-access organizations in accordance with sections 1152 and 1153 of the Act and our regulations at 42 CFR 462.102 and 462.103. In addition, the organization must not be a health care facility, health care facility association, or a health care facility affiliate, and must have a consumer representative on its governing board. A physician-sponsored organization is one that is both composed of at least 10 percent of the licensed doctors of medicine or osteopathy practicing medicine or surgery in the respective review area and is representative of the physician practicing in the review area. The representation requirement can be met if the organization has documentation in its files demonstrating that it is composed of at least 20 percent of the licensed doctor of medicine and osteopathy practicing medicine or surgery in the review area; or, if the organization demonstrates, through letters of support from physicians or physician organizations, or through other means, that it is representative of the area physicians. A physician-access organization is one that has available to it by arrangement or otherwise, the services of a sufficient number of licensed doctors of medicine or osteopathy practicing medicine or surgery in the review area to assure adequate peer review of the services furnished by the various medical specialties and subspecialties. The organization meets this requirment if it demonstrates that it has available to it at least one physician in every generally recognized specialty; and has an arrangement or arrangements with physicians under which the physicians would conduct review for the organization. Written statements of interest must be recieved no later 5:00 p.m. EST, (30 days after the date of CBD publication). With the written statement of interest the organization must furnish materials that demonstrate that it meets the definitionn of an in-State organization. (0047)

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