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
Background
The Department of State Health Services (DSHS) is seeking a Contractor to recover money under a subrogation or third-party reimbursement right held by DSHS arising from payment of medical expenses, specifically medications provided by the AIDS Drug Assistance Program (ADAP).
The Texas HIV Medication Program (THMP), which has been in existence since 1987, provides medications for the treatment of HIV and its related complications for low-income Texans. ADAP is a federally funded DSHS state administered program authorized under Part B of Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009. In addition to ADAP, THMP oversees programs that help pay premiums and drug co-pays for Medicare clients and those with private insurance.
Work Details
The Contractor will conduct activities to assist DSHS THMP with ensuring ADAP provides HIV medications as a safety net. Key responsibilities include:
- Identifying individuals not eligible for ADAP due to insurance.
- Back-billing appropriate health insurance companies.
- Safeguarding confidential client data.
- Performing monthly dataset matching to identify clients with other health insurance benefits.
- Conducting investigations on potential third-party liabilities.
- Providing monthly reports on investigation results.
- Executing both automated and manual Third-Party Liability activities.
The Contractor must also develop a transition plan, maintain communication with various entities, ensure compliance with HIPAA, and provide adequate cash control procedures.
Period of Performance
The initial term of the contract will be for one year, with the possibility of extending for up to four additional years at DSHS's discretion. The contract may also include an additional option period not exceeding one year following the base term and any allowable renewals.
Place of Performance
The services will be performed in Texas, specifically related to the operations of the Texas HIV Medication Program.
