Third Party Administrator (TPA) to bill State Medicaid for Correctional Healthcare Services

The Solano County Sheriff’s Office is seeking to establish a contract with a qualified third-party administrator (TPA) to handle billing services for healthcare provided to inmates under the CalAIM JI Reentry Initiative. The selected TPA will be responsible for submitting claims to California’s Department of Health Care Services (DHCS) to secure Medicaid reimbursements for correctional healthcare services. The procurement process involves distributing the RFQ in February 2025, followed by a selection process that includes interviews and demonstrations in March or early April, with the goal of finalizing the contract by the end of June 2025. The contract will support planning activities starting in July 2025, aiming for a program launch date of September 29, 2026. The contract size is estimated between $500,000 and $2,000,000, and the solicitation is posted under the NAICS code 541219, indicating a professional, scientific, and technical services provider. The contract will incorporate specific special terms and conditions, including provisions for contract extensions, termination rights, and insurance requirements such as errors and omissions and malpractice coverage. It emphasizes contractor responsibilities like conducting audits, maintaining bonding, and adhering to federal and state health care regulations, including HIPAA compliance, confidentiality of mental health records, and reporting child or adult abuse. Additional clauses address amendments, default notifications, and indemnification, especially concerning healthcare professionals. The contractual documentation also includes attachments related to drug-free workplace certification and abuse reporting, ensuring compliance with legal and safety standards. Overall, the initiative aims to streamline billing processes for correctional healthcare services and maximize Medicaid reimbursements through a carefully structured contractual and operational framework.