Medicaid Medical Frailty Determination Services

The Department of Health Care Policy and Financing (HCPF) is seeking information from vendors to better understand their capabilities in providing 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 provide information on their clinical operations, operational capacity, implementation approach, and reporting capabilities. The Department is interested in understanding how vendors can support timely determinations, ensure consistency among reviewers, and maintain quality across determinations. Some key points to consider: • The Department is looking for vendors with experience in providing similar services to Medicaid populations. • Vendors should describe their clinical staffing model, reviewer qualifications, and quality assurance process. • The Department is interested in understanding how vendors can accommodate varying workload and support state oversight, quality assurance, appeals, reporting, and related administrative processes. • Vendors should provide information on their technology platforms, data requirements, and reporting capabilities. • The Department welcomes recommendations from vendors regarding industry best practices, operational models, staffing approaches, reporting capabilities, technology solutions, and any other considerations that would improve the effectiveness or efficiency of these services.