Contractor Requirements: Scope of Work 2.1 Summary Statement This Request for Proposals (RFP) is issued to procure the goods or services, as specified in this Section 2, from a contract between the selected offeror(s) and the State of Maryland (“State”). The State is issuing this solicitation to hire a Contractor to assist the Maryland Health Services Cost Review Commission (HSCRC) in adjudicating full rate reviews, analyzing health systems’ cost structures, and assessing, reviewing, and evaluating proposed changes to some methodologies under Maryland. Code, Health-General Article § 19-201 et seq., or to support the HSCRC in other reviews of a similar nature. 2.2 This project includes the following tasks • Assisting with Full Rate Reviews • Assessment of Health Systems’ Cost Structure • Financial and Regulatory Review 2.2 Background and Purpose HSCRC is an independent state agency responsible for setting the rates Maryland’s hospitals may charge for healthcare services. The HSCRC sets an annual “Update Factor” to adjust overall hospital rates to account for inflation and population growth, and other regular adjustments. Additionally, hospitals may submit a Full Rate Application to the HSCRC if they believe that they have insufficient rates to provide healthcare services. The HSCRC adjudicates these Full Rate Reviews based on a combination of 1) the reasonableness of a hospital’s regulated cost structure, 2) how reasonably charges are related to costs, and 3) performance in total cost of care, both historically and while under the TCOC Model. Hospitals’ relative cost efficiency is assessed using the Inter-Hospital Cost Comparison methodology, which evaluates the cost per case of providing healthcare after adjusting for hospital-specific drivers of healthcare costs – such as the costs of providing graduate medical education and the costs associated with complex socio-economic determinants of health. Hospitals may appeal the HSCRC’s ruling if they believe that the decision does not align with the HSCRC’s enabling statute or the State’s Administrative Procedure Act. The HSCRC can also review many of these same factors in circumstances other than a Full Rate Review.
