Financial Policy Review Services

The Vendor is required to provide adjudicating full rate reviews, analyzing health systems’ cost structures, and assessing, reviewing, and evaluating proposed changes to some methodologies under state.
- The Commission also employs several methodologies to adjust hospital global budgets, including the case mix methodology, which is a unique approach to measuring hospital utilization by comparing inpatient and outpatient services on a common scale.
- The state uses the results to measure market shifts in service use between hospitals and to estimate volume growth due to demographic changes, as well as other irregular volume shifts (deregulation, repatriation, and out-of-state volume change).
- The hospital has the burden to prove that its proposed rates will enable it to provide the most effective and efficient service.
- This may include an assessment of the impact that commission policies have on the hospital’s cost structure and modelling the impact of different policy alternatives.
- This will include the creation of charts and figures and may include drafting significant portions of responses to the Full Rate Review.
 
•    The hospital’s labor costs, including physician compensation, are reasonable given local labor market conditions; 
•    The hospital’s operating costs, including purchasing costs for medical drugs and supplies, are reasonable given local conditions and the size and complexity of the hospital; 
•    The hospital’s capital costs are reasonable given financial market conditions, the age of the hospital’s physical assets, and the patient volume those assets most support; 
•    The hospital’s corporate structure, including the ownership and cross subsidization of other healthcare entities, is conducive to efficient operations; 
•    The hospital’s financial reserves are sufficient given the hospital’s debt and liquidity needs.
- Health care access and quality include key issues, such as access to health care, access to primary care, health insurance coverage, and health literacy. Access to both health care and quality improvement is an important factor in ensuring that patients receive the best care possible.

- Contract Period/Term: 3 years
- Pre-Bid Conference Date: January 13, 2026
- Questions/Inquires Deadline: January 21, 2026