Estimated Release Dates provided are based on calendar year and are subject to change.
- Procurement Number: 31865-00627
- Release Date: July 20, 2022
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.
Fiscal Employer Agent
- Procurement Number: 31865-00633
- Release Date: September 20, 2022
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).
National Core Indicators Adult in Person, and Child and Family Surveyor Entity
- Procurement Number: 31865-00628
- Projected Release Date: September 15, 2022
The State intends to secure a provider for National Core Indicators (NCI) surveys as used across states to assess the quality and outcomes of Developmental Disability (DD) services provided to individuals with Intellectual and Developmental Disabilities (IDD) and their families. NCI offers valid, reliable, person-centered measures that states use to demonstrate how publicly funded supports are impacting people’s lives and to determine where they can improve the quality of those supports. NCI surveys help states measure important elements of person-centered planning, outcomes, and satisfaction in domains such as self-determination; service coordination and access; relationships and community inclusion; rights, choices, and decision-making; employment status and goals; health, welfare and safety. NCI Child and Family Surveys (NCI-CFS) serve a similar purpose: to assess the quality and outcomes reported by families of children with IDD receiving services through the Katie Beckett Program.
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: 4th Quarter 2022 or 1st Quarter 2023
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.es1.html
Administering Entity (AE) Systems In The Affordable Care Act (ACA) Program Audit Services
- Procurement Number: 31865-00630
- Release Date: September 19, 2022
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).posals--rfp--opportunities1.html
Development of Reimbursement Rate Structure for Nursing Facilities, DSH Auditing Services, and CPE Calculation in Tennessee
- Procurement Number: 31865-00631
- Release Date: September 12, 2022
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.
Non-Emergency Medical Transportation (NEMT) Credentialing, Audit, and Complaint Management Information System
- Procurement Number: RFI 31865-00709
- Release Date: October 10, 2022
The State of Tennessee, Division of TennCare (TennCare), Office of Contract Management (OCM) issues this Request for Information (RFI) to gain deeper insight into the blockchain solutions available to meet TennCare’s needs related to online credentialing, auditing, and complaint management of Tennessee’s Medicaid Non-Emergency Medical Transportation (NEMT) benefit.
The State of Tennessee’s Medicaid program provides health care for approximately 1.7 million Tennesseans. Non-Emergency Medical Transportation (NEMT) is a Medicaid benefit that supports the overall health and wellness of beneficiaries by providing transportation to individuals that require assistance getting to and from healthcare services and other locations where services are provided that support the beneficiary’s wellbeing. TennCare maintains partnerships with Amerigroup, BlueCross / BlueShield of Tennessee, and United Healthcare to administer Medicaid NEMT services in the State. These Managed Care Organizations (MCO) utilize NEMT brokers to manage over 125 transportation providers (TP) and to coordinate the service delivery of transportation to TennCare members to and/or from their healthcare appointments. This includes annually performing more than 1.5 million trips serving approximately 80,000 unique members at an annual cost of approximately $85 million.
This RFI is intended to identify blockchain technology solutions in the market that demonstrate the capacity to meet TennCare’s NEMT objectives:
- Establish a centralized credentials repository
- Reduce administrative burdens across NEMT transportation providers, NEMT transportation brokers, MCOs, and TennCare
- Reduce credentialing costs for NEMT transportation providers, NEMT transportation brokers, MCOs, and TennCare
- Promote collaborative credentialing among NEMT transportation providers, NEMT transportation brokers, MCOs, and TennCare
- Improve speed and thoroughness of audit capabilities
- Promote proactive compliance checks among NEMT transportation providers, NEMT transportation brokers, MCOs, and TennCare
- Adopt tools to fight fraud, waste, and abuse
- Adopt tools to intake, triage, refer and/or escalate TennCare member complaints against NEMT transportation providers, NEMT transportation brokers, and MCOs
- Improve the quality of NEMT services in communities across Tennessee
- Highlight and recognize high-performing NEMT transportation providers, NEMT transportation brokers, and MCOs
Nationally Accredited Workforce Development Competency-Based Learning and Training Program
- Procurement Number: RFI 31865-00710
- Release Date: October 14, 2022
The State of Tennessee, Division of TennCare (TennCare), Long Term Services and Support (LTSS) issues this Request for Information (“RFI”) for the purpose of gaining insight into the solutions available to meet TennCare’s needs related to access to a nationally accredited credentialling system for Direct Support Professionals (DSPs) working in Tennessee for the administration, documentation, tracking, reporting and delivery of workforce development competency-based training programs.
The RFI is intended it identify solutions in the market that meet the following needs:
- Has a system that can offer a national certification after completing a nationally accredited comprehensive competency-based training program(s) for individuals paid to deliver LTSS.
- A secured System that adheres to all identity management standards, protected information is maintained in an encrypted environment and is only accessible to authorized users.
- Interoperability with Shareable Content Object Reference Model (SCORM).
- Capability of assigning access level roles by an administrator, instructor, individual user, reports, security access, and more.
- Ability to create a registry/database that collects and maintains credentials, badges earned, and/or certifications by learners for completing the nationally accredited course modules and training programs.
- Reports by course, learner, agency/location, date range, and more such as job title, work group, location/region, year, month, etc.
- Ability to develop learner profiles that are searchable in multiple ways (ex: learner name, ID, job title, active/inactive learner status, date of hire, course title, date ranges, etc)
- A system that would allow for reporting and analytics.
- Ability to deliver services online and development activities seamlessly between a PC and mobile devices.
- Capability to import historical learner data from other applications in formats such as text files, csv, comma delimited, and rtf.
- Ability to measure, benchmark, report, and predict the impact of the nationally accredited learning programs.
- Ability to accredit created content as needed
Close Loop Referral System
- Procurement Number: 31865-00635
- Release Date: November 18, 2022
TennCare seeks a Contractor for the design, development, implementation, and operation of a public, cloud-based Closed-Loop Referral System (CLRS) (the “Solution”) that is centered on Service Oriented Architecture (SOA), delivered as Software as a Service (SaaS), and meets all the following requirements:
1) Non-Medical Needs Assessment: A standardized Non-Medical Needs Assessment embedded within the Solution and the ability for the Solution to import Non-Medical Needs Assessments from external sources (e.g., Electronic Health Record Systems).
2) Community Resource Directory: Ability to match the Non-Medical Needs Assessment results with a comprehensive, interactive, and up-to-date Community Resource Directory, with each Authorized User able to identify the Community-Based Organization's (CBO) service-related information including, but not limited to, hours of operation by location, address, service eligibility requirements, capacities, and limitations. The Community Resource Directory shall be available via a public domain to Non-Authenticated Users to conduct searches for available resources.
3) Non-Medical Risk Factors Referral System: Ability to send Referrals to CBO(s), act as a conduit for CBOs to electronically receive Referrals and track the Referral outcomes.
4) Referral Tracking: Capability to associate Referrals to a Member, and maintain, monitor, and track each Referral over time.
5) Data Analytics: Enable Authorized User(s) to generate operational data and analytics from the Solution.
- Procurement Number: 31865-00637
- Projected Release Date: 3rd Quarter 2023
TennCare seeks to select a contractor to maintain a statewide administrative services only contract for medical services and care management. Contractor will be required to maintain a statewide network of providers across all areas of medical and behavioral health services and pay claims and manage care for the population that is enrolled with this contractor.
Dental Benefits Management (DBM) Program
- Procurement Number: 31865-00636
- Projected Release Date: 4th Quarter 2023
The State seeks to identify a Contractor for the statewide provision of Dental Benefits Management (DBM) services for five (5) separate State DBM Programs (collectively referred to as the “State DBM Programs”), which include:
1) TennCare Children’s DBM Program, which is part of the TennCare Program, and administers dental services to approximately 900,000 eligible enrollees under age 21;
2) TennCare Employment and Community First (ECF) CHOICES Program, which administers covered adult dental benefits to approximately 5,500 eligible adults age 21 and older who have an intellectual or developmental disability and are enrolled in TennCare ECF CHOICES;
3) TennCare Adults with Intellectual or Developmental Disabilities Dental Program, which administers covered dental benefits to approximately 6,500 adults age 21 and older with Intellectual or Developmental Disabilities (IDD) that are enrolled in the Section 1915(c) Home and Community Based Services (HCBS) Waiver (TennCare 1915(c) Dental Program);
4) TennCare Adult Dental DBM Program, which administers covered adult dental benefits to approximately 650,000 eligible adults age 21 and older who are TennCare members;
5) CoverKids DBM Program, which is part of the federal Children’s Health Insurance Program (CHIP), referred to in Tennessee as the CoverKids Program (CoverKids) which is a self-funded health plan providing certain dental benefits to approximately 40,000 eligible enrollees under age 19 enrolled in CoverKids medical coverage.
*POSTED – Central Procurement Office (CPO) Request for Proposals (RFP) Opportunities