DEPARTMENT OF DEFENSE (CMP), OCHAMPUS/CMP, BLDG 225, AURORA CO 80045-6900

Q -- NATIONAL QUALITY MONITORING SERVICES SOL MDA90696R0004 DUE 010697 POC Contract Specialist, SCOTT LAMOND, 303-361-1249, or, Laura L. Sells, Contracting Officer, 303-361-1020, or telefax 303-361-1154 The Office of Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) will be conducting a full and open competition for the award a contract for National Quality Monitoring Services (NQMS). The purpose of the proposed contract is to assist the Office of the Assistant Secretary of Defense for Health Affairs (OSAD(HA)), the TRICARE Support Office, the Department of Defense Uniformed Services, and the Department of Defense Health Care Region Lead Agents by providing the following services. (1) Provide the government with an independent and impartial evaluation of the patient care managed by all Managed Care Support (MCS) contractors by: (a) Validating utilization management decisions made by Military Treatment Facilities (MTFs), MCS contractors, and other contractors to assure that appropriate care is authorized. (b) Monitoring the quality of care provided to ensure that quality standards are met and health care delivered to beneficiaries is not compromised by financial incentives. (c) Providing an independent appeals level of medical necessity denials where that denial has been made by the MTF, MCS contractor, and other at-risk contractors. (2) Perform facility certification activities for Residential Treatment Centers (RTCs), Substance Use Disorder Rehabilitation Facilities (SUDRF), and Psychiatric Partial Hospitalization Programs (PHP) in accordance with the provisions of CHAMPUS Regulation (DoD 6010.8-R), Chapter 6, and the TRICARE/CHAMPUS Policy Manual. (3) Provide Peer Review services for OCHAMPUS as follows; (a) Provide Internal and External case peer review (medical/surgical and mental health), (b) Perform Organ transplant reviews, (c) Provide witness appearance at Hearings and Trials, and Discovery and/or attendance at OCHAMPUS (hearing Officer) conferences. Offerors for the NQMS must either be a Peer Review Organization or must commit to performing review functions using a Peer Review Organization. Any offeror that is or has arrangements with a MCS contractor to perform utilization review is not eligible for award of this contract. All requests for a copy of the solicitation must be submitted in writing and provide the name and telephone number of the point of contact for the organization, and complete mailing address. Written requests may be submitted by telefax. Currently, the solicitation release date is on or before November 4, 1996. Submission of proposals will be at least 60 calendar days after release of the solicitation.(0290)

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