S & L - NC DHHS Due Process (Appeals) Clearinghouse - MRAS

The General Services Administration (GSA), on behalf of S & L, is conducting market research to develop a Due Process (Appeals) Clearinghouse for the North Carolina Department of Health and Human Services (DHHS). This initiative is designed to ensure compliance with federal and state due process requirements for Medicaid beneficiary appeals and grievances, as stipulated under the 14th Amendment, 42 CFR Subpart F, and North Carolina General Statutes 108A-70.9 and 108D. The clearinghouse will support the transition to Medicaid Managed Care, where DHHS oversees both Medicaid Direct (Fee-for-Service) and Managed Care programs through its Division of Health Benefits (DHB).

The primary objective of this solicitation is to develop a secure, centralized web-based platform that can efficiently handle documents related to adverse benefit determinations (NABDs), appeals, mediations, and State Fair Hearings. The system must provide secure access for all authorized agencies involved in the appeals process including the Office of Administrative Hearings (OAH), Managed Care Organizations (MCOs), Utilization Review vendors, legal entities, and internal policy experts ensuring timely access to critical information.

The proposed solution should feature secure password-protected access, centralized electronic storage with robust reporting capabilities, data analytics functions, and daily or on-demand document uploads from various stakeholders. The platform must also confirm successful uploads or report errors within a 24-hour timeframe. Additionally, it should support expedited appeals requiring resolution within 72 hours while meeting all federal and state requirements regarding due process in Medicaid service decisions.

Vendors are invited to describe how their solutions would integrate with DHB's existing Enterprise Architecture and Medicaid Integration Services platform for data ingestion and security services. They are also asked to provide insights into their tools' features for building, operating, automating solution functions as well as generating reports. Further inquiries include required business resources for implementation support as well as IT resources necessary for operational maintenance. Vendors should also present a rough order of magnitude estimate covering implementation costs, software licensing fees, cloud hosting expenses alongside expected timeframes for different project phases.