Health Care Financing Administration, Office of Acquisition and Grants, PHSCD, C-2-21-15, 7500 Security Boulevard, Baltimore, Md., 21244-1850

Q -- OPERATION OF UTILIZATION AND QUALITY CONTROL PEER REVIEW OR GANIZATION (PRO) FOR THE STATE OF HAWAII SOL HCFA-95-080/CK POC CHRISTINE KOURKOULES, CONTRACT SPECIALIST, (410) 786-5152. The Health Care Financing Administration (HCFA) plans to issue a Request for Proposal (RFP) to designate an organization as a Peer Review Organization (PRO) for the State of Hawaii, which includes Guam and American Samoa. In order to be eligible to receive a PRO contract, an offeror must meet the definition of a ''utilization and quality control peer revew organization'' as set forth in Section 1152 of the Social Security Act (the Act). PROs are responsible for the review of certain health care services furnished under Title XVIII of the Act and under certain other Federal programs to determine whether those services are reasonable, medically necessary, furnished in the appropriate setting and are of a quality which meets professionally recognized standards. PRO activities are part of the Health Care Quality Improvement Program (HCQIP), a program which supports the mission of HCFA to assure health care security for eligible beneficiaries. The HCQIP is carried out locally by the PRO in each State. The HCQIP rests on the belief that a provider's or practitioner's internal quality management system is the key to good health care plan performance. Under the HCQIP, PRO's provide medical reviews (for example, quality indicators and health care information for health care plans, providers, and practitioners) to improve the quality of care furnished to Medicare beneficiaries. The organizations that are eligible to contract as PROs have satisfactorily demonstrated that they are either physician-sponsored or physician-access organizations in accordance with Sections 1152 and 1153 of the Act and our regulations at 42 CFR 462.102 and 462.103. In addition, the organization must not be a health care facility, health care facility association, or a health care facility affiliate, and must have a consumer representative on its governing board. In addition, PROs are responsible for certain other activities necessary or incident to the performance of the contract. All requirements are included in the RFP. The definition, contract requirements, functions and duties of PROs are generally defined by Titles XI and XVIII of the Act. There is a possibility that a pre-solicitation conference will be held with interested firms responding to this synopsis. If so, the time, date and location of such a pre-solitation conference will be determined at a later date. Th RFP for the PRO for the State of Hawaii, which includes Guam, and American Samoa, will be available approximately 15 days after publication of this notice. Proposals submitted uner RFP-HCFA-95-080/CK will be due 75-90 days from the date of the RFP release. Telephone requests will not be honored. (0216)

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