26-70009-000 - Statewide Integrated Health Care Provider Network RFP

The California Department of State Hospitals (DSH) is soliciting proposals for a Statewide Integrated Health Care Provider Network (HCPN) to provide community-based specialty medical services. The contract includes the implementation of a Third Party Administration (TPA) and Utilization Management (UM) system, featuring Prior Authorization (PA) services. The anticipated performance period begins March 1, 2027, for an initial term of up to three years, with the possibility of two one-year extensions. Award selection is based on the best overall value, utilizing a three-step scoring process that evaluates technical capabilities and cost, provided the proposer meets minimum qualifications including legal right to do business, three professional references, and agreement to insurance requirements. The selected contractor must adhere to strict professional standards, including NCQA PA/UM standards, The Joint Commission requirements, and HIPAA and CMIA privacy regulations. Key deliverables include the submission of business continuity, disaster recovery, and transition-out plans within 60 calendar days of the contract effective date. The contractor is responsible for providing all necessary laboratory supplies and specimen transport materials, such as sterile containers and locked transport bags, at no additional cost. Financial requirements include the maintenance of performance and payment bonds not less than the contract price, with invoicing submitted monthly in arrears. The agreement is subject to a 30-day cancellation notice by the DSH and requires signed acceptance from the DSH Contract Manager for payment processing.