SLCo SHE130291 Medicaid 1115 Waiver - RFC

Salt Lake County, through its Contracts and Procurement office on behalf of the Sheriff’s Office Jail Health Services Division, is seeking a contractor to manage Medicaid claim submission and administration under the 1115 Medicaid Waiver for incarcerated individuals who received Medicaid-covered services or medications during the final 90 days of their incarceration. The initiative initially targets approximately 90 participants enrolled in Medication-Assisted Treatment (MAT) and is designed to expand to all eligible inmates as the program matures. The contractor must seamlessly integrate with the County’s Saphire Health EHR system to ensure secure data exchange for eligibility verification, claim submission, and record access while adhering to all County IT security, privacy, and GRAMA compliance standards. A dedicated Account Manager must be assigned to oversee operations, with additional billing specialists deployed as claim volume requires. The contractor is responsible for training County staff on identifying and validating eligible claims, submitting monthly reports on claim submissions, reimbursements, denials, and resolution timelines, attending quarterly performance reviews, and providing an annual compliance audit summary with process improvement recommendations. The contractor must demonstrate a minimum of three years’ experience in submitting Medicaid claims and pass all background check requirements, including submitting original BCI criminal history reports for all personnel with access to inmate medical records. Proposals are evaluated under a Lowest Price Technically Acceptable (LPTA) model, with technical acceptability determined by compliance with mandatory requirements such as submitting required certifications, proof of insurance with prior acts coverage, non-debarment status, environmental compliance, and vendor references. Pricing is the sole differentiating factor, based on a percentage of settled claims submitted in the Pricing Schedule. All submissions must be made electronically via the Bonfire portal by the June 24, 2026 deadline, and no physical proposals are accepted. The contract will be non-exclusive, allowing the County to procure similar services from other vendors. The County will provide inmate demographic, booking, custody, and release data; facilitate secure access to medical records; and approve technical integrations. Invoicing must reference the contract number and comply with County financial policies, with payments administered by the Mayor’s Office of Financial Administration. The contractor must retain records for seven years post-completion, maintain insurance for three years after contract closure, and immediately report any changes to certifications such as debarment status or employment of veterans. Federal compliance requirements including the Davis-Bacon Act, Anti-Kickback Act, Clean Air Act, and Clean Water Act apply if federal funds are involved, along with Utah’s