Health Care Financing Administration 7500 Security Blvd.MS C2-21-15, Baltimore, MD. 21244-1850

Q -- OPERATION OF UTILIZATION AND QUALITY CONTROL PEER REVIEW ORGANIZATION (PRO) FOR THE STATES OF ILLINOIS, DELAWARE, HAWAII, WISCONSIN,AND KANSAS SOL HCFA-99-001/ELH POC Edward L. Hughes, Contracting Officer, (410) 786-0203 The Health Care Financing Administration (HCFA) plans to issue Requests for Proposals (RFP) to select entities as the Peer Review Organization(PRO)for the states of Illinois, Delaware, Hawaii, Wisconsin and Kansas. In order to be eligible to receive a PRO contract, an offeror must be deemed a responsible entity in accordance with Federal Acquisition Regulation (FAR) Part 9.1 and must meet the definition of a "utilization and quality control peer review organization" as set forth in section 1152 of the Social Security Act (the Act). Organizations that are eligible to contract as PROs must have satisfactorily demonstrated that they are either physician-sponsored or physician-access organizations in accordance with Sections 1152 and 1153 of the Act and the regulations set forth at 42 CFR 462.102 and 462.10. 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. PROs are responsible for the review of certain health care services furnished under Title XVIII of the Act and under certain other Federal programs to determine whether those services are reasonable, medically necessary, furnished in the appropriate setting, and are of a quality which 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. The HCQIP is based upon the premise that a provider or practitioner's internal quality management system is a key element in good health care plan performance. Under the HCQIP, PROs provide medical reviews to improve the quality of care furnished to Medicare beneficiaries. PROs are responsible for certain other activities necessary or incident to the performance of the contract. All requirements are included in the RFP. The definition, contract requirements, functions and duties of PROs are generally defined by Titles XI and XVIII of the Act. The RFPs for each state noted in this announcement will be available approximately 15 days after publication of this notice. Interested parties must submit a written request to the Contracting Officer at 7500 Security Boulevard, MS C2-21-15, Baltimore, MD 21244-1850. Telephone and facsimile requests will not be honored. Posted 01/18/99 (I-SN288759). (0018)

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