Upcoming Procurements

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

eDiscovery  and Data Management Services and Solutions (Request for Information)

  • RFI Number:  31865-00718
  • Projected Release Date:  April 17, 2024
  • Summary:

TennCare is seeking information pertaining to eDiscovery and data management services and solutions. This Request For Information (RFI) seeks to obtain information assisting the Agency in identifying current practices and services related to the eDiscovery process, litigation hold and case management, and enterprise data management tools.

Analytics  Support Services (Request for Information)

  • RFI Number: 31865-00717
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare is constantly seeking to derive greater value from its data holdings, which include the data on eligibility and enrollment and healthcare utilization for more than three million past and current members as well as data on affiliated providers. As part of its strategic plan, TennCare intends to enhance the agency’s analytic capacity and expand the analytic tools it uses in order to attain its goals around financial stewardship, improved access to care, better health outcomes, and enhanced member experience.

TennCare has existing internal analytic teams that are supported by general and specialist contractors. Approximately 40 state staff members are in analytic roles, including staff in three core internal analytics teams supporting financial and administrative reporting, program integrity, and health care quality improvement and reporting teams in Member Services, Long Term Services and Supports, and Strategic Planning and Innovation. TennCare has existing contractors supporting actuarial analyses as well as general federal, state, and administrative reporting in the areas of member eligibility and enrollment, providers, healthcare utilization (claims and encounters), financial operations, and value-based programs.

TennCare is making transformative investments to create an enterprise-wide data ecosystem, scheduled for initial go-live in 2024-2025. The ecosystem (which includes an enterprise data warehouse, a modern ETL system that will incorporate Master Data Management to improve data quality and consistency, and a fully featured Decision Support System) will allow us to combine data across business units and systems in ways we have previously been unable to and to deploy modern analytic approaches such as predictive algorithms and machine learning.

In addition to these technological advances, the agency continues to update its approach to managing its data, including robust efforts in improving governance, quality, and security. TennCare has developed strategic plans for analytics and data governance to achieve higher value from its data.

The ASC is intended to be strategically deployed within TennCare to support the agency in deriving greater value from our data. The potential contractor will focus on two areas: 1) building general agency capacity in data analytics as well as 2) contributing consulting expertise to support state staff in the completion of high priority, high complexity analytic projects. The ASC will not generally be used to complete routine reporting, for creation of new dashboards, or for operation of reporting or decision support systems.

ACTIVE GRANT OPPORTUNITY: Community Health Worker Infrastructure Project

  • Grant Procurement Number: 31865-00017
  • Projected Release Date: 2nd Quarter 2024 
  • Summary:

According to the American Public Health Association, a Community Health Worker (CHW) is “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.” 1 CHWs serve as links between the community and health/social services to expand access to care and improve health outcomes.2 CHWs can hold a variety of roles, some of which include facilitating care coordination, providing health education, and advocating for the members of the community. CHWs are uniquely equipped to excel in these roles because they share similar life experiences to the individuals and communities they serve.

CHWs have been shown to improve health outcomes, lower health care costs, and reduce health disparities when integrated into communities in a coordinated, intentional model of care. CHWs who have a focus on specific populations, such as perinatal CHWs, can also add additional impact to the communities they serve. Perinatal CHWs serve pregnant and postpartum individuals and specialize in connecting families to services, offering continuity for the clinical care team, and being the bridge between vulnerable populations with clinical and social service providers. Through these services, PCHWs have been shown to improve health outcomes for babies and birthing people. However, in trying to achieve consistent, meaningful health outcomes while bending the medical cost curve, CHWs and organizations who employ CHWs have varied experiences and success. In Tennessee, the CHW workforce is a growing and important new area of opportunity. Many CHW organizations across Tennessee are actively working to build infrastructure and invest key resources to sustainably grow their programs. With these grants, the Division of TennCare aims to address some challenges that exist in this current Tennessee Landscape for organizations that support TennCare members. Currently, it is challenging to define the CHW workforce as there is no standard definition for the CHW identity or role. Organizational infrastructure around best practices for the support of CHWs and CHW supervisors can be fragmented, under-resourced, or have high variation. These barriers, and others, prevent CHWs from serving Tennesseans to the best of their ability.

The Division of TennCare is working to address social determinants of health (SDOH) in its member population through its Health Starts Initiative. TennCare’s Health Starts work includes investing in Tennessee’s (CHW) workforce, and in turn, serving TennCare members by supporting the building of critical infrastructure for CHWs to ensure sustainable, impactful, and positive return-on-investment. This funding opportunity is to invest in CHW infrastructure and support CHWs in meeting key CHW program standards and best practices. Additionally, improving maternal health outcomes remains a top priority for TennCare and will also be an additional focus area of this grant. Special consideration will be given to applicants focused on addressing social needs within the maternal health population as part of this grant.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFA. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Provider Services Solution

  • Procurement Number:  31865-00652
  • Projected Release Date: 4th Quarter 2024
  • Summary:

TennCare seeks to select a contractor that will successfully implement a Provider Services Solution, with optional services for Enrollment Specialists, Call Center Support, and Site Visit Support for the State. The Solution will serve as the system of record for TennCare Provider Registration/Enrollment data, and should meet the following at a minimum:​ ​

- Use automated screening and monitoring processes and tools to verify provider enrollment and eligibility based on Federal requirements contained in 42 CFR 455.436

- Meets the requirements set forth in Tenn. Code Ann. (TCA) § 56-7-1009 regarding health care provider credentialing applications from the Council on Affordable Quality Healthcare (CAQH)

- Improve provider data quality through seamless integration with CAQH ProView

- Reduce the administrative burden of Medicaid providers

- Improve provider-related business process efficiencies and data accuracy using configurable business rules, modernized technologies and practices​

- Improve the provider data reporting capabilities between TennCare and CMS

- Reduce the manual effort and administrative burden to TennCare through integration, automation​, and reporting 

- Successfully attain CMS Certification 

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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EMPLOYMENT AND COMMUNITY FIRST (ECF) CHOICES TRAINING & TECHNICAL ASSISTANCE, AND PRE-ADIMISSION SCREENING AND RESIDENT REVIEW (PASRR) PROCESSES AND SERVICES (REISSUE)

  • Procurement Number: 31865-00650
  • Release Date: February 2, 2024
  • Summary:

The State of Tennessee, Division of TennCare (TennCare), Long Term Services and Supports (LTSS) is seeking a contractor to provide Employment and Community First (ECF) CHOICES Training and Technical Assistance, Pre-Admission Screening and Resident Review (PASRR) processes, services related to medical or Level of Care (LOC) eligibility assessments and appeals for Long-Term Services and Supports (LTSS), , and Supports Intensity Scale™ (SIS™) assessments. These services will need to incorporate the following:

- Training and Technical Assistance related to the following: training and certifying staff to perform the Maladaptive Behavior Assessment component of the Inventory for Client and Agency Planning (ICAP), Life Skills Assessment training, development of an electronic tool to calculate the Maladaptive Behavior Index Score, processes for conducting post-scoring audits of Maladaptive Behavior Assessment, and targeted training and technical assistance to improve assessment accuracy and performance.

- Pre-Admission Screening and Resident Review (PASRR) process: Level I assessment, Level II assessment, and appeals.

- Medical or Level of Care (LOC) eligibility assessments and appeals for Long-Term Services and Supports (LTSS) programs.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Enterprise Testing Services

  • Procurement Number: 31865-00651
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare seeks to select a Contractor to centralize User-Acceptance (UAT) testing services in support of TennCare business units. The selected Contractor will support and oversee user acceptance testing (UAT) activities across TennCare MMIS modules and business applications. The Contractor will be responsible for providing testing resources and services to support quality assurance activities for the release of new applications/modules and enhancements to operational applications/modules that will include test script creation and review, test execution, incident reporting and defect re-testing, and test automation support for UAT and Operation & Maintenance phases. The Contractor is expected to provide appropriately skilled and experienced testing resources (i.e., Manual/Functional testers, UAT Script Development Leads/Business Analysts, Technical Testers (ETL/Batch testing), and potentially Automation Engineers) for each applicable business unit with the goal of improving testing rigor and the overalhor.tn.gov/sites.html/contl quality of work completed. This transformation to a centralized enterprise capability will serve to modernize the future of TennCare User Acceptance Testing (UAT) by improving the quality of existing manual UAT collateral, and with a strong emphasis on minimizing manual regression testing and increasing test automation.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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TENNESSEE ELIGIBILITY DETERMINATION SYSTEM (TEDS)

  • Procurement Number: 31865-00648
  • Projected Release Date: 3rd Quarter 2024
  • Summary:

TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, and enhance TennCare’s Tennessee Eligibility Determination System (TEDS). The TEDS platform includes data collection, application registration, eligibility determination and appeals, and correspondence functionality for applicants and members to Tennessee Medicaid and/or Children’s Health Insurance Program (CHIP), Pre-Admission Evaluations and Referrals for Long Term Services and Support (PERLSS), and Medical Appeals Tracking System (MATS) for medical services. It also includes member-facing and partner-facing portals and a mobile application.

TEDS is the TennCare solution that establishes and maintains eligibility for Medicaid and CHIP.

PERLSS is the TennCare Long-Term Services and Supports (LTSS) solution that manages and tracks medical evaluations to determine enrollment in several Long-Term Services and Supports programs.

MATS is the TennCare Medical Appeal Tracking System used to manage Member medical services appeals

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible

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PREPAID INPAITIENT HEALTH PLAN (PIHP)

  • Procurement Number: 31865-00637
  • Release Date: November 7, 2023
  • Summary:

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.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Dental Benefits Management (DBM) Program

  • Procurement Number: 31865-00636
  • Release Date: January 3, 2024
  • Summary:

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.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

https://tennessee.na1.adobesign.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhAIFUbrg-Fr5AEfVYF-JHrsoSNhDv3PRKlydHMPycIoMnaQVYezu6jLjTmUs12r99Q*

Bridge Conferencing and Recording Service

  • Procurement Number: 31865-00642
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

In accordance with state and federal laws, TennCare conducts administrative hearings regarding eligibility determinations and adverse actions. These hearings are overseen by Administrative Judges, are typically conducted by phone, and must always be recorded and preserved. TennCare seeks a contractor to provide bridge conferencing services through which such hearings may be conducted, recorded, and archived.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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SOC Managed Services

  • Procurement Number: 31865-00641
  • Projected Release Date: 1st quarter 2024
  • Summary:

TennCare seeks to select a Contractor to provide Managed Security Services (MSS) on a 24x7x365 basis.  The Contractor will perform continuous monitoring, analysis and reporting of security alerts and event information from approved security feeds, create and manage custom detection content for TennCare’s SIEM platform, and collect, process, and analyze threat intelligence data to determine if TennCare’s systems are affected with the latest cyber threats.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Asset Verification System

  • Procurement Number: 31865-00645
  • Projected Release Date: 1st Quarter 2024
  • Summary:

TennCare seeks to select a contractor to provide electronic verification of resources to be used in the TennCare application and renewal processes.  Contractor will be required to maintain a national link to financial institutions to provide near real time verification and identification of assets.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Member Services Contact Center

  • Procurement Number: 31865-00649
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare seeks a Contractor that shall provide the staff, the facility, and Technology of the management of a States TennCare Member Services Contact Center furnished Contact Center solution (hereinafter referred to as “TennCare Connect” or “Contact Center” to support TennCare and Children’s Health Insurance Program (CHIP) eligibility services for individuals seeking to obtain and maintain eligibility for TennCare and CHIP. The Division of TennCare (“TennCare”) is the single state agency designated by the State and the Centers for Medicare and Medicaid Services (CMS) to administer the federal Medicaid program (known in Tennessee as “TennCare”) pursuant to Title XIX of the Social Security Act (42 U.S.C § 1396 et seq.) and the Section 1115 research and demonstration waiver granted to the State and any successor programs by CMS. TennCare also administers the federal Social Security Act Title XXI Children’s Health Insurance Program (CHIP), known as “CoverKids” in Tennessee, which provides certain self-funded health plan services to eligible children under age nineteen (19), including unborn children who are covered from conception to birth.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Value -Based Payment (VBP) Program Consulting Services

  • Procurement Number: 31865-00647
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare seeks to select a contractor that will help TennCare develop and implement a coordinated value-based payment (VBP) strategy that advances accountability for quality and total cost of care that aims to meaningfully improve the health and health care experience of TennCare members. The VBP strategy will include the evaluation of existing TennCare VBP programs, designing and implementing enhancements to existing TennCare VBP programs, and the exploration of expanding the TennCare VBP portfolio.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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Pharmacy Benefits Administrator (PBA)

  • Procurement Number: 31865-00654
  • Projected Release Date: 4th Quarter 2024
  • Summary:

The State of Tennessee, Department of Finance and Administration, Division of TennCare administers the TennCare Pharmacy Medicaid Program pursuant to a waiver (State Plan) from the Centers for Medicare and Medicaid Services (CMS). In addition, TennCare administers two commercial pharmacy programs, CoverRx and CoverKids. These three programs are collectively referred to herein as the “TennCare Pharmacy Programs” or “Programs”. The TennCare Pharmacy Programs offer prescription drug benefits to approximately 1.5 million members and contract with a third-party service organization, a Pharmacy Benefits Administrator (PBA), to manage prescription drug benefits on their behalf. The PBA offers a variety of services, including but not limited to claim adjudications, customer service call centers, clinical services such as prior authorizations, drug utilization reviews, rebate administration, and mail-order pharmacy. Although the TennCare Pharmacy Programs outsource these services to the PBM, the Programs remain responsible for the compliance and accuracy of the services the PBM performs pursuant to the following controls: PBM contract with TennCare, State Plan Amendment, rules and regulations, and Centers for Medicare and Medicaid Services (CMS) federal guidance and requirements.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFP.  The Attestation must be returned to the Solicitation Coordinator as soon as possible.

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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 and mitchell.d.plumer@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