Medicaid Medical Frailty Determination Services

The Department of Health Care Policy and Financing (HCPF) is seeking information from vendors regarding their capabilities to provide independent medical frailty determination services for Medicaid members. The services include evaluating medical, behavioral health, and functional information to determine if an individual's condition significantly impairs their ability to comply with Medicaid community engagement requirements. Vendors should describe their clinical operations, operational capacity, implementation approach, and reporting capabilities. The Department is interested in understanding how vendors would ensure consistency among reviewers, maintain quality across determinations, and support state oversight, quality assurance, appeals, and related administrative processes. Some key aspects of the job include: * Receiving referrals from counties or other designated eligibility entities * Reviewing available medical, behavioral health, and functional documentation * Requesting additional supporting documentation when necessary * Conducting clinical reviews and, when appropriate, interviews or other information gathering activities * Evaluating whether an individual's condition substantially limits the individual's ability to comply with Community Engagement requirements * Documenting the clinical rationale supporting each determination * Supporting HCPF during appeals, audits, and quality assurance activities