QUALITY MEASURES

THIS IS SOURCE SOUGHT IS TOTAL FOR SMALL BUSINESS Below is the statement of work and discription of the software we are seeking. The lic. and program will be equal to the software provided by Milliman Care Guidelines - their product call Care Guide QI. The hospital will utilize this software in accordance with the information: ________________________________________________________________________ PROFESSIONAL QUALITY SERVICES STATEMENT OF WORK I. BACKGROUND Northern Navajo Medical Center is an Indian Health Service facility located in Northwestern New Mexico. The facility provides a full range of inpatient service including pediatrics, medical-surgical, obstetrics, intensive and surgical care. Ambulatory services are provided in various clinics and the hospital emergency dept. The hospital receives funding from the Centers for Medicare and Medicaid is required to adhere to the Centers for Medicare and Medicaid conditions of participation guidelines, and Joint Commission regulations. II. PURPOSE The purpose of the contract is to provide quality measures to promote improved safety and quality of care, more informed and consistent clinical decisions Proactive care management and discharge planning. Better management for complicated patients and extended stays. All hospitals must abide by the Centers for Medicare Services Conditions of participation regulations. All admissions must have certification documentation on the chart to support medical necessity of the admissions or continued stay. Software will allow the utilization review coordinator a tool to use for assessment of the admissions and continued hospital stays and documentation for certification of Medical necessity for the admissions, and to justify billing Medicare, Medicaid and private insurance. The utilization review coordinator will use the evidence-based criteria established to assess for medical necessity. II. CONTRACT TASK TO BE PERFORMED This is a non-personal service contract for licensure, which is an evidence based software program to be used by the Utilization Review Coordinator and medical staff as a tool that enables proactive quality driven care III. CONTRACT TASKS TO BE PERFORMED. The contractor shall provide the licensure web program and the web-based interactive software and also provide on demand comprehensive online training on the product. The contractor will be responsible for all Federal, State and local taxes. . IV NECESSITY OF OBTAINING A TOOL FOR MEASUREMENT MEDICAL NECESSITY CRITERIA All admissions and continued stay must have documentation on the chart of Certification of medical necessity. The web base will provide evidenced based criteria to be used for Efficient chart review. The software program enables reviewers to access clinical resources and Tools for assessment of treatment and medical necessity