Upcoming Procurements

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

Incarceration Data Services (Request for Information)

  • RFI Number:  31865-00715
  • Projected Release Date:  July 15, 2024
  • Summary:

The State of Tennessee, Department of Finance and Administration, Division of TennCare (TennCare), Member Services will be issuing a Request for Information (“RFI”) for the purpose of gaining deeper insight into the solutions available to meet TennCare’s needs related to the receipt of county-level incarceration data for purposes of the suspension of eligibility per TCA § 71-5-106.  TennCare will be seeking information and insight from experienced vendors to help identify the industry’s best practices, approaches, and technologies. 

The RFI will be intended to identify solutions in the market that meet the following needs:

  • A web services data-sharing solution or an Application Program Interface (API) integration that contains current and accurate data relating to the county-level incarcerated population in Tennessee’s county jails, including, but not limited to:
    • First name, last name, Social Security Number, and date of birth
    • Indicator relating the level of match on the basis of demographic data
    • Arrest/incarceration date
    • Ninety (90) day Incarceration date
    • Release date
    • Release indicator (to indicate whether individual is in jail, work furlough, or is being released)
    • ail/facility name, address, phone number, and county
  • A web services data-sharing solution/API that can be transmitted on a daily, or real-time/near-real time basis to the Division of TennCare’s Medicaid Management Information System (MMIS).
  • A web services data-sharing solution/API that is legally compliant with all applicable privacy laws and regulations.
  • A web services data-sharing solution/API that has demonstrated success in aggregating and transmitting county-level incarceration demographic data in Tennessee or another state.

Estate Recovery

  • Procurement Number: 31865-00657
  • Projected Release Date:  1st Quarter 2025
  • Summary:

Estate Recovery is the way TennCare collects money from the estates of people who passed away and received TennCare long-term services and supports, such as nursing home care or home and community based services. If TennCare pays for nursing facility and other long term care services, TennCare is required by federal law to recoup these payments after the death of the recipient.

TennCare seeks a contractor to provide administrative support for its estate recovery program. The contractor will be responsible for:

- maintaining and improving estate recovery’s current case management system

- handling incoming and outgoing calls from the estate recovery hotline

- providing in-office staff to support the TennCare estate recovery team

-locating assets of TennCare members and producing title searches

-filing TennCare estate recovery claims with the appropriate court

*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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ACTIVE  GRANT OPPORTUNITY: Psychiatric Hospital Grant

  • Grant Procurement Number:  31865-00916
  • Projected Release Date: 3rd Quarter 2024  
  • Summary:

Psychiatric Hospitals provide the highest level of care for TennCare members with mental health or co-occurring substance use disorders during acute psychiatric crises and provide mental and physical health stabilization. Planning for discharge occurs at the time of admission and the managed care organizations (MCOs) work with the hospital to develop appropriate discharge plans for the member. An essential element of discharge planning is the promotion of continuity of care post hospitalization. Continuity of care for members leaving psychiatric hospitalization is achieved through ongoing collaboration between Psychiatric Hospitals, Behavioral Health Outpatient Providers, and the MCOs. Through development of infrastructures that prioritizes the Outpatient Provider’s and MCO’s involvement in a member’s admission, treatment, and discharge from psychiatric hospitals, readmission rates and follow-up after hospitalization rates are improved, leading to better outcomes for the member.

The Division of TennCare is working to improve access and quality of care for members receiving mental and physical health stabilization within the Psychiatric Hospital setting. Funding opportunities may be available for Psychiatric Hospitals who are serving, or are committed to begin serving, special and complex populations. In addition to serving complex and/or special populations, TennCare is seeking candidates who are committed to cultivating a collaborative relationship with Outpatient Behavioral Health Providers and the Managed Care Organizations’ (MCOs) Case Management Teams. The goal of these relationship will be to promote continuity of care and high-quality treatment and discharge planning. Psychiatric Hospitals will use funding to improve facilities, develop workforces, enhance relationships and collaborations with Behavioral Health Outpatient Providers and MCOs’ Case Management Teams, and other needed services/supports to care for the identified populations. 

 

*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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eDiscovery and Litigation Support (Request for Qualification)

  • RFQ Number:  31865-00656
  • Projected Release Date:  4th Quarter 2024
  • Summary:

TennCare seeks to select a contractor with the appropriate qualifications and experience necessary to meet TennCare’s needs relating to comprehensive assistance with document production in response to lawsuits and public records requests, data and image capture, litigation hold management solutions, and management of TennCare business records. These services will include providing licensed attorneys and other litigation support upon request.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation, listed below, associated with this RFQ.  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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Enterprise Testing Services

  • Procurement Number: 31865-00651
  • Projected Release Date: 3rd 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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Web-Based Audio Teleconferencing Service

  • Procurement Number: 31865-00642
  • Projected Release Date: 3rd 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: 3rd 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: 3rd 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: 3rd 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: 3rd 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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Care Coordination Tool (CCT)

  • Procurement Number:  31865-00653
  • Projected Release Date:  4th Quarter 2024
  • Summary:

The Care Coordination Tool (CCT) will be a cloud-based population health management technology platform for healthcare providers to improve care delivery of their TennCare members. The CCCT will help stratify the clinical risk of attributed members, aggregate clinical data to identify care gaps, provide insight into quality metrics, and identify care coordination activities to aid in quality improvement. The CCT will also share data feeds including real time Admissions, Discharge, and Transfer (ADT) feeds from hospitals and display attribution so that providers can easily see which TennCare members are assigned to them and identify opportunities for improved transitions of care. This tool will also integrate with the TennCare health plan provider portals to allow providers to perform certain programmatic functions within the tool.

The primary users of the CCT will be TennCare providers enrolled in two of the state’s value-based payment programs, Patient Centered Medical Home and Tennessee Health Link. Patient Centered Medical Home is the state’s primary care value-based program aimed at improving quality and cost of care for TennCare members. Tennessee Health Link providers deliver care coordination for TennCare members with the highest behavioral health needs. You can find more information about the programs on the Primary Care Transformation web page.

*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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Request for Information (RFI)) Non-Emergency Medical Transportation (NEMT) Credentialing, Audit, and Complaint Management Information System

  • RFI Procurement Number:  31865-00720
  • Projected Release Date:  July 15, 2024
  • Summary:

The State of Tennessee, Division of TennCare (TennCare), Office of Contract Management (OCM) issues this Request for Information (RFI) to determine what commercial-off-the-shelf (COTS), software-as-a-service (SaaS), or platform-as-a-service (PaaS) solutions currently exist related to online credentialing, auditing, and complaint management of the Medicaid Non-Emergency Medical Transportation (NEMT) benefit. Respondents to this RFI must have an existing COTS, SaaS, or PaaS solution. TennCare is not seeking information concerning a design, development, and implementation (DDI) solution.

The State of Tennessee’s Medicaid program provides health care for approximately 1.4 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 WellPoint, 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 available commercial-off-the-shelf (COTS), software-as-a-service (SaaS), or platform-as-a-service (PaaS) solutions currently in the market that employ blockchain technology and offer the following functionality to TennCare’s NEMT objectives:

  • Centralized credentials repository
  • Centralized document repository
  • NEMT provider credentialing review and approval workflow
  • NEMT audit review and approval workflow
  • NEMT complaint management review and approval workflow
  • Functionality to facilitate real-time audit of documents and credentials of the NEMT drivers, Transportation Providers, NEMT Transportation Brokers, Managed Care Organizations, and state Medicaid agency’s NEMT program
  • Functionality to facilitate flags and alerts to fight NEMT provider fraud, waste, and abuse
  • Functionality to facilitate intake, triage, referral, and escalation workflows to manage TennCare member complaints against NEMT drivers, NEMT transportation providers, NEMT Transportation Brokers, and TennCare’s MCOs, and the state Medicaid agency’s NEMT program
  • Reports functionality

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