Upcoming Procurements
Estimated Release Dates provided are based on calendar year and are subject to change.
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.
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.
eDiscovery and Litigation Support (Request for Qualification)
- RFI 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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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