Wisconsin Department of Health Services (DHS), Division of Health Care Access and Accountability (DHCAA), with the DHS Bureau of Strategic Sourcing (BSS)
10/23/15 3:00 PM CT
Contract to a qualified Wisconsin business or organization to determine eligibility of applicants for personal care assistance under their medical insurance plan. September 21 is the deadline for questions to be submitted. Applicants will conduct needs assessments for individuals to determine their need for assistance with activities of daily living, but will not oversee, manage, or participate in providing those services.
The DHCAA is seeking to contract with a vendor who can assist with the following goals and objectives that have been set forth:
• To ensure covered PCS services are medically necessary and provided in quantities appropriate to the member’s unmet need for covered services based on the severity of their medical condition, functional disability, or physical or cognitive impairment;
• To provide IA services in a manner that ensures that there are no actual or potential conflicts of interest with entities or individuals providing PCS;
• To promote consistent application of screening criteria and level of service determination;
• To ensure the validity and reliability of PCS assessments and procedures;
• To automate all business processes required to effectively and efficiently manage this process, including assessments, Physician Orders, member and Provider notifications, and process status reports;
• To automate the IA processes addressed in this RFP in a manner that will provide readily available data to the Department to monitor and manage costs, quality, utilization and compliance with federal and state statutes, rules, regulations, policies, and guidelines; and
• To develop and automate uniform reporting in a comprehensive interactive database.
Personal Care Services are a covered benefit under Wisconsin’s MA program. A PCS Provider under the written Orders of a physician performs Personal Care Services. Personal Care Services assist a member with Activities of Daily Living (ADLs) necessary to maintain the member in his or her place of residence in the community and include assistance with bathing, feeding, toileting, mobility, and other activities.
When appropriate, PCS may also include assistance with Medically Oriented Tasks (MOTs) that are supportive of nursing care and require special medical knowledge or skill. Personal Care Services may also include services Incidental to Activities of Daily Living (IADLs) such as laundering members’ personal clothing, light cleaning in essential areas of the residence during personal care activities, and meal preparation.
GrantWatch ID#: 161946
Estimated Start date for performing assessments: 8/1/2016
The contract shall be effective on the date indicated on the purchase order or the contract execution date and shall run for three (3) years from that date, with an option by mutual agreement of the agency and contractor, to renew for two one-year extensions.
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Fax Number: (608) 264-9874
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