Third Party Health Insurance Verification and Reimbursement Collection

📄Description

Executive Summary

The Departmentof State Health Services (DSHS) is seeking a Contractor to recover money undera subrogation or third-party reimbursement right held by DSHS arising frompayment of medical expenses, specifically medications provided by the AIDS DrugAssistance Program (ADAP).

HHSC PCS willadminister the procurement process for this Solicitation, which includes RFPpublication, handling of communications from vendors, as well as managing thereceipt of Solicitation Responses for review and evaluation.

Scope of Work

The Texas HIVMedication Program (THMP), which has been in existence since 1987, providesmedications for the treatment of HIV and its related complications forlow-income Texans. The THMP is the official ADAP for the State of Texas. ADAPis a federally funded DSHS state administered program authorized under Part Bof Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009.In addition to the ADAP, THMP also oversees the State Pharmacy AssistanceProgram which coordinates with Medicare clients to help pay premiums and drugco-pays; and the Texas Insurance Assistance Program, which wraps around privateinsurance to help pay premiums and drug co-pays.

ADAP providesapproved medications to low-income, uninsured, or underinsured people livingwith HIV who have no other means to obtain these necessary and/or life-savingmedications. To qualify for medications for any of the three programs,potential clients who meet eligibility criteria must complete an applicationfor assistance.

Contract Term

Theinitial term of any Contract resulting from this Solicitation will be for aperiod of one (1) year. DSHS, at its sole option, may extend anyContract awarded pursuant to this Solicitation for up to four (4) additionalyears.

Followingthe base term and any allowable renewals or extensions, DSHS may extend anyresulting Contractfor not more than one additional option period to address immediate operationalor service delivery needs. If the resulting Contract does not include a definedoption period, the extension is limited to one year.

Optional/Pre-proposal Conference

WebinarInformation:

Attendees must register for the webinar at the followinglink:

https://attendee.gotowebinar.com/register/2609482383084081499

** After registration, participants will receive anotheremail with

the actual link to the webinar. **

Scheduleof Events

EVENT

DATE/TIME

Date of Release

November 7, 2024

Pre-proposal Conference and HSP Training

Attendance is Optional

November 13, 2024, at 10:00 a.m. Central Time

Deadline for Submitting Questions or Requests for Clarification

November 14, 2024, at 3:00 p.m. Central Time

Tentative Date Responses to Questions or Requests for Clarification Posted on ESBD

November 21, 2024

Deadline for courtesy HSP review

November 26, 2024, at 3:00 p.m. Central Time

Deadline for Submission of Solicitation Responses [NOTE: Responses must be RECEIVED by HHSC by the deadline.]

December 10, 2024, at 10:30 p.m. Central Time

Evaluation Period

January 2025

Anticipated Notice of Award

April 2025

Anticipated Contract Start Date

May 2025

🏷️Commodity Codes (NIGP)

94610-Accounting And Billing Services (Including Payroll Services, 3Rd Party Reimbursement For Medicare, Medicaid, Private Insurance, Etc);94633-Collection Services, Financial Debt;94807-Administration Services, Health;95352-Insurance And Insurance Services (Not Otherwise Classified);95861-Insurance And Risk Management Services;95877-Project Management Services;