Utilization Review Software

Background
The Gallup Indian Medical Center (GIMC), located in Gallup, NM, is a 127-bed healthcare facility that operates 24/7. The center requires a contractor to provide a site-hosted, evidence-based clinical criteria software and license for use in the hospital's utilization review process. This software is essential for evaluating clinical criteria related to various healthcare services and ensuring compliance with the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation.

Work Details
The contractor shall provide a site-hosted, evidence-based clinical criteria software that allows users to evaluate clinical criteria for the following services:
1. Observation services
2. Inpatient admissions
3. Continued inpatient stays
4. Evaluation of discharge planning
5. Evaluation of ambulatory surgical services for appropriateness of setting
6. Transition of care to rehabilitation, subacute, and skilled nursing services
7. Evaluation of substance use disorders and transition of care
8. Transition of care needs utilizing CMS Durable Medical Equipment
9. Retrospective evaluation of risk management and quality care delivery evaluation.

The software must support at least 12 simultaneous users per location and include features such as keyword searches, CPT codes, ICD-10 codes, and generate various utilization review reports including variance days and medical necessity met. The contractor is also required to provide initial onsite training and ongoing technical support throughout the contract duration.

Period of Performance
Base Year: 10/01/2026 - 09/30/2027; Option Year 1: 10/01/2027 - 09/30/2028; Option Year 2: 10/01/2028 - 09/30/2029; Option Year 3: 10/01/2029 - 09/30/2030; Option Year 4: 10/01/2030 - 09/30/2031.

Place of Performance
Gallup Indian Medical Center, 516 East Nizhoni Blvd, Gallup, NM 87301.

Bidder Requirements
Bidders must comply with the Small Business Set Aside - Total (SBA) status. Additionally, the contractor's software must comply with HIPAA regulations regarding Protected Health Information (PHI) and must be FedRAMP certified if cloud-based. The contractor must also provide a Business Associate Agreement ensuring compliance with privacy standards.