Upcoming Procurements

Estimated Release Dates provided are based on calendar year and are subject to change.

MMIS CORE

  • Procurement Number: 31865-00627
  • Projected Release Date: 3rd Quarter 2022
  • Summary:

TennCare seeks to replace the legacy Medicaid Management Information System (MMIS) through a set of modular solutions centered on Service Oriented Architecture (SOA), delivered as Software as a Service (SaaS), which will include the design, development, implementation, operation, and maintenance of the following three modules:

 Member Enrollment (ME) Module: The ME Module shall automate the assignment and Enrollment of Members to Managed Care Contractors (MCCs) based on the application of Eligibility data to TennCare Business Rules and policies. The ME Module shall also house the information for existing and newly added Health Plans and Health Benefits.

Financial Management (FM) Module: The FM Module shall support the centralized management and oversight of TennCare’s financial accounting, accounts payable, receivables/recoveries, reconciliation, budget management, and financial reporting activities across the enterprise. The FM Module shall integrate with the State Accounting System to ensure proper accounting and management of funds in alignment with Comptroller of the Treasury (COT) requirements.

Encounter Processing (EP) Module: The EP Module shall support the centralized management of Encounter data received from Managed Care Contractors or a Third-Party Adjudicator. The EP Module shall receive and process Encounter data, and apply edits and audits based on TennCare Business Rules.

Planning Assistance for Dual Eligible Services Pertaining to Long-Term Services and Supports (LTSS) Programs

  • RFI Procurement Number: 31865-00707
  • Release Date: May 18, 2022
  • Summary:

TennCare is seeking information and insight from experienced and financially sound organizations to perform analytic, policy, and program administration services, including possible outsourcing functions, for the Department to develop, implement, and oversee a state roadmap to improve programs for individuals dually eligible for Medicare and Medicaid.

Pharmacy Reimbursement Services

  • Procurement Number: 31865-00632
  • Release Date: June 15, 2022
  • Summary:

TennCare seeks to select a contractor able to maintain the CMS (Centers for Medicare and Medicaid Services) - required pharmacy reimbursement methodology which includes average actual acquisition cost-based ingredient pricing and professional dispensing fees rates for single-source and multi-source legend, Over the Counter (OTC) drugs, specialty, clotting factor and other products paid for via the TennCare pharmacy benefit; and to provide 340B technical (i.e., Estimated Ceiling Price File) and reporting services.

Fiscal Employer Agent

  • Procurement Number: 31865-00633
  • Projected Release Date: 3rd Quarter 2022
  • Summary:

The State intends to secure a single statewide contract for the purpose of performing Financial Administration and Supports Brokerage functions for Consumer Direction of Home and Community Based Services (HCBS) relevant to TennCare home and community based services provided across Medicaid programs and authorities, including the TennCare CHOICES in Long-Term Services and Supports Program (CHOICES),Employment and Community First CHOICES Program (ECF CHOICES), the Section 1915(c) HCBS Waiver Programs, and the Katie Beckett Programs. The Contractor shall be able to perform all services described in the Scope of Services of the pro forma contract (RFP Attachment 6.6).

The Administration of a Survey instrument and the Collection of Quality Outcomes Data for Outcome-Based Satisfaction and Culture Change/Quality of Life from TennCare’s Medicaid Nursing Facilities

  • Procurement Number: 31865-00634
  • Projected Release Date: 3rd Quarter 2022
  • Summary:

The Contractor will be responsible for the administration of a survey instrument and the collection of annual survey data for outcome-based Satisfaction and Culture Change/Quality of Life measures from each of TennCare’s Medicaid nursing facilities for purposes of determining value-based nursing facility payments in TennCare’s Quality Improvement in Long Term Services and Supports (QuILTSS) Initiative. TennCare utilizes the data collected from the survey to determine value-based nursing facility payments as well as analyzing the data to identify state and national trends and advance opportunities for quality improvement.

Administering Entity (AE) Systems In The Affordable Care Act (ACA) Program Audit Services

  • Procurement Number: 31865-00630
  • Release Date: 3rd Quarter 2022
  • Summary:

TennCare seeks a contractor to provide audit services for the annual attestation of the Minimum Acceptable Risk Standards for Exchanges (MARS-E) security and privacy controls mandated by the Centers for Medicare & Medicaid Services (CMS).

Development of Reimbursement Rate Structure for Nursing Facilities, DSH Auditing Services, and CPE Calculation in Tennessee

  • Procurement Number: 31865-00631
  • Release Date: 3rd Quarter 2022
  • Summary:

TennCare seeks a Contractor to assist the State in designing and maintaining a reimbursement rate structure for nursing facilities in Tennessee with Medicaid patients that are paid a daily per diem for each patient. The per diem consists of several components, including but not limited to: direct care, indirect care, fair rental value, acuity, quality, and a tax pass-through. The Contractor will also conduct the annual audit of the State’s Disproportionate Share Hospital (DSH) payments and will provide an annual calculation of the State’s Certified Public Expenditure (CPE) amount.

If you are interested in any of the above procurements and would like further information, please email matt.brimm@tn.gov with a cc to Donovan.Morgan2@tn.gov.

*POSTED – Central Procurement Office (CPO) Request for Proposals (RFP) Opportunities

http://tn.gov/generalservices/procurement/central-procurement-office--cpo-/supplier-information/request-for-proposals--rfp--opportunities1.html