Network180 - Independent Review Organization - Medical Necessity Consulting/Advisory Services

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
REQUEST FOR PROPOSALS
Independent Review Organization - Medical Necessity Consulting/Advisory Services
PROCUREMENT ISSUED BY:
KENT COUNTY CMH AUTHORITY d/b/a NETWORK180
790 Fuller Ave NE, Grand Rapids, Michigan 49503
www.network180.org
Issue Date: June 9, 2026
Deadline to Submit Questions: June 19, 2026
Deadline to Submit Proposals: July 2, 2026
Contract Start Date: October 1, 2026
Issue Date: June 9, 2026 1

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
CONTENTS
I. OVERVIEW ......................................................................................................................... 3
II. PROCUREMENT DETAILS ................................................................................................... 3
A. Deadline ....................................................................................................................... 3
B. Method and Form of Submission ................................................................................ 3
C. Questions and Responses ............................................................................................. 3
D. Modifications ............................................................................................................... 3
E. Acceptance of Proposal Content ................................................................................. 3
F. Rejection of Proposals ................................................................................................. 4
G. Proposal Evaluations ................................................................................................... 4
H. Contract Award(s) ........................................................................................................ 4
I. Right to Re-Bid ............................................................................................................. 4
J. Incurring Costs ............................................................................................................. 4
K. Disclosure .................................................................................................................... 4
L. Appeals ........................................................................................................................ 4
III. SCOPE OF SERVICES ........................................................................................................... 5
IV. VENDOR ELIGIBILITY/REQUIREMENTS ............................................................................. 7
A. Vendor Accreditation ................................................................................................... 7
B. Contract Terms ............................................................................................................ 7
C. Conflicts of Interest ..................................................................................................... 7
D. Debarment and Suspension ........................................................................................ 7
V. CONTENT OF PROPOSAL ................................................................................................... 7
A. Vendor Eligibility Form ................................................................................................ 8
B. Services Proposal .......................................................................................................... 8
C. Evaluation Questions and Cost Proposal ..................................................................... 8
D. References ................................................................................................................... 8
EXHIBIT A - SERVICES AGREEMENT ................................................................................................ 9
EXHIBIT B - VENDOR ELIGIBILITY APPLICATION ........................................................................... 15
EXHIBIT C - EVALUATION CRITERIA AND COST PROPOSAL ......................................................... 17
Issue Date: June 9, 2026 2

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
1. OVERVIEW
Kent County CMH Authority d/b/a Network180, the Community Mental Health Authority in Kent County,
seeks an Independent Review Organization (vendor) to perform advisory professional external review
organization consulting services, directly and through its Board certified medical review specialist and
consultants in psychiatry, addition medicine, and behavioral health care, as described in Section 3 -
Scope of Services.
Network180 is a community mental health authority under the Michigan Mental Health Code and is part
of the Lakeshore Regional Entity Pre-Paid Inpatient Health Plan (PIHP). Its programs and services are
supported and funded, in part, by the Kent County Board of Commissioners and the Michigan
Department of Health and Human Services and are administered by the Kent County Community Mental
Health Authority Board.
Visit https://www.network180.org/ for additional information about Network180 and its current
services and activities.
2. PROCUREMENT DETAILS
A. Deadline
The deadline for submission of proposals is 5:00 p.m. Eastern on July 2, 2026. Proposals
received after this date and time will not be considered.
B. Method and Form of Submission
Proposals must submitted by email to Network180 at procurement@network180.org. The
email's subject line must include the title of this RFP. The contents of the proposal, including file
type and content requirements, are defined below in Section 5 - Content of Proposal.
C. Questions and Responses
Bidders may submit written questions regarding this RFP to Network180 by emailing
procurement@network180.org no later than 5:00 p.m. Eastern on June 19, 2026.
Responses to written questions submitted before the date identified above will be posted at
https://www.network180.org/procurement by 5:00 p.m. Eastern on June 24, 2026.
D. Modifications
Network180 reserves the right to withdraw the procurement opportunity at any point during
the process, and to update and/or modify the requirements of this procurement opportunity at
any time. Modifications to this procurement opportunity will be posted at
https://www.network180.org/procurement.
E. Acceptance of Proposal Content
The contents of the proposal of the successful bidder will become obligations of the awarded
contract. Failure of the successful bidder to accept these obligations may result in cancellation
of the contract.
Issue Date: June 9, 2026 3

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
F. Rejection of Proposals
Network180 reserves the right to reject any or all proposals submitted responsive to this RFP, or
to negotiate separately with any source whatsoever in any manner necessary to serve the best
interests of Network180.
Network180 does not intend to award a contract solely based on any response made to this
request or otherwise pay for the information solicited or obtained. Network180 may request
clarification from any bidder under active consideration and may give any Bidder an opportunity
to correct defects in its proposal.
G. Proposal Evaluations
Submitted proposals will be evaluated by a procurement review team in the following areas:
1) Vendor Eligibility/Adherence to RFP Instructions (10%)
2) Vendor Experience (35%)
3) Services Proposal (35%)
4) Cost Proposal (20%)
H. Contract Award(s)
Bidders will be notified in writing of the decision to award/not award a contract for submissions
under this procurement opportunity. Network180 reserves the right to award one or more
contracts, or to make no award at all, under this procurement process.
The successful bidder selected through this process will be awarded a contract beginning
October 1, 2026. This contract may be renewed annually up to four (4) years, based on
Network180's continued need for services and evaluation of vendor performance.
The contract will substantially be in the form of Exhibit A - Services Agreement, which may be
referenced below.
I. Right to Re-Bid
Network180 reserves the right to rebid all or some components of this Request for Proposals
(RFP) in the event of significant changes to Medicaid Policy or other future federal, state, or
locally applicable laws, regulations, or policies.
J. Incurring Costs
Network180 is not liable for any cost incurred by bidders prior to issuance of a contract.
K. Disclosure
All information submitted in response to this public Request for Proposals may be divulged
under the provisions of the Freedom of Information Act (FOIA). Confidential or proprietary
information cannot be shielded from disclosure under the FOIA requirements for a public bid
process.
L. Appeals
Appeals are limited to alleged violations of the procurement process and may not address the
qualitative review by the review teams. It is bidder's responsibility to become familiar with and
fully informed regarding the terms, requirements, and specifications of this RFP. Lack of
understanding and/or misinterpretation of any part of this RFP is not cause for an appeal.
Issue Date: June 9, 2026 4

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
Appeals must be submitted in writing by email to procurement@network180.org within ten (10)
days of the date on which Network180 sends its decision to award/not award a contract to the
contact listed on the bidder's submission, and must contain the following:
1) An identification of alleged violation(s) of the procurement process;
2) Specific information supporting the alleged violation(s); and
3) Indication of whether bidder will be represented by legal counsel during the appeal
process, and if so, contact information for legal counsel.
3. SCOPE OF SERVICES
Network180 seeks an Independent Review Organization ("vendor") to perform advisory professional
external review organization consulting services, directly and through its Board certified medical review
specialist and consultants in psychiatry, addition medicine, and behavioral health care (the "Peer
Reviewers"), and to render advisory consulting services on matters of medical necessity and/or medical
appropriateness of treatment on cases requested by Network180.
Advisory services relate to reviews of inpatient/crisis residential/partial hospitalization criteria for
medical necessity for adults and children with serious mental illness, serious emotional disturbance,
intellectual and developmental disabilities, and co-occurring disorders.
Vendor will provide advisory consulting services on matters concerning medication management and
medical necessity and/or medical appropriateness of mental health and substance use disorder services
as requested by Network180. Such reviews shall be completed within time frames mutually agreed upon
by Vendor and Network180. Upon completion of an advisory review or consultation, Vendor shall
provide a report, including advisory opinions, to Network180.
Estimated Annual Volumes
In the 18-month period preceding release of this RFP, Network180 processed approximately 322
Adverse Benefit Determinations following denial of continued stay for inpatient hospitalization, partial
hospitalization, or crisis residential services. Network180 also processed approximately 150 provider
requests for reconsideration of a claims denial (9 expedited and 141 standard).
Over the same 18-month period, Network180 submitted between 2-8 cases per week to its current IRO,
of the following types:
* 116 inpatient
* 4 partial hospitalization
* 11 crisis residential
* 2 ECT
Expected Timeframes for Completion of Reviews
Vendor will make available Peer Reviewers to commence such consulting services within a reasonable
period of time after receiving a request for case review from Network180. Network180 requires that
standard reviews are completed (from time of assignment to completion of review) within 30 calendar
days. All services provided in response to a case review request shall be deemed completed upon
Issue Date: June 9, 2026 5

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
delivery of vendor's final report responsive to such request; however, vendor will promptly respond to
follow-up clarification questions when a final report is unclear, incomplete, or has an error.
Network180 requires that expedited reviews are completed (from time of assignment to completion of
review) within 2 business days.
Clinical Reviewer Requirements
* All clinical reviewers assigned to Network180 appeal cases must meet the following minimum
qualifications: Licensed physician, board-certified psychiatrist, addictionologist, or licensed
behavioral health clinician with an active, unrestricted license in good standing and clinical
expertise appropriate to the type of review requested.
* For physician advisor reviews, third-party reconsideration reviews, expedited reviews, standard
reviews, retrospective reviews, and peer-to-peer consultations, the assigned reviewer must be a
board-certified psychiatrist, addictionologist, or physician with similar credentials and clinical
expertise to those who typically treat the condition or health concern under review.
* Demonstrated clinical experience in inpatient psychiatric care, behavioral health treatment,
substance use disorder treatment, and medical necessity review.
* Current knowledge of evidence-based clinical criteria used for behavioral health level-of-care
determinations, including inpatient psychiatric hospitalization, partial hospitalization, and crisis
residential programming. Familiarity with applicable criteria, standards, and requirements,
including the Michigan Medicaid Provider Manual, MCG Behavioral Health Care Guidelines,
ASAM criteria as applicable, the Michigan Mental Health Code, and federal, state, regional, PIHP,
and Network180 requirements.
* Free from any conflict of interest with Network180, its contracted providers, or the member
whose case is under review.
Vendor Accreditation Requirements
Vendor must hold current, active accreditation as an Independent Review Organization (IRO) issued by
URAC (Utilization Review Accreditation Commission). Accreditation must be in good standing at time of
proposal submission and maintained for the duration of any resulting contract.
Vendors holding URAC Health Utilization Management (HUM) accreditation in addition to IRO
accreditation are preferred. Proof of current accreditation status must be submitted with the proposal
response.
Additional Terms
Vendor shall require that its Peer Reviewers use their best medical and clinical judgment in performing
consulting services hereunder and to render advisory recommendations to Network180 in accordance
with standard medical practice and Network180's applicable policies and procedures. Peer Reviewers
shall not perform any type of professional or diagnostic or treatment services, or any other direct
medical care in the carrying out of the duties of this Agreement.
Vendor shall screen the Peer Reviewer for conflicts of interest on the case prior to assigning the Peer
Reviewer.
Issue Date: June 9, 2026 6

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
Notwithstanding any advisory recommendation which may be made by vendor, it is expressly
acknowledged by both parties that Network180 shall at all times remain responsible for making any
determination concerning the medical necessity of a proposed or rendered service which impacts the
provision of benefits to a Network180 member for such service. Vendor shall only be deemed to be
providing advisory services with respect to such recommendations; and shall not be construed to be
making final determinations, claims processing, or employee payment determinations or other similar
determinations. All such authority and responsibility for such determinations remain with Network180.
4. VENDOR ELIGIBILITY/REQUIREMENTS
A. Vendor Accreditation
Vendor must hold current, active accreditation as an Independent Review Organization (IRO)
issued by URAC (Utilization Review Accreditation Commission). Accreditation must be in good
standing at time of proposal submission and maintained for the duration of any resulting
contract.
Vendors holding URAC Health Utilization Management (HUM) accreditation in addition to IRO
accreditation are preferred. Proof of current accreditation status must be submitted with the
proposal response.
B. Contract Terms
Vendor will execute a contract with Network180, which will include the terms stated in Exhibit A
- Services Agreement. The services and cost proposals submitted responsive to this RFP will be
the basis of the contract's Statement of Work and Compensation Schedule.
C. Conflicts of Interest
Bidders must disclose any actual, potential, or perceived conflicts of interest with Network180
relating to this RFP and the services described herein.
D. Debarment and Suspension
Bidders must acknowledge that they agree to comply with Federal regulation 42 CFR Part 180
and certifies they: 1) are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any federal department or
agency; 2) have not been convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (federal, state, or local) transaction or contract under a public commission
of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property; 3) are not presently indicted or otherwise criminally or
civilly charged by a government entity (federal, state, or local) with commission of any of the
offenses enumerated above, and 4) have not had one or more public transactions (federal,
state, or local) terminated for cause or default.
5. CONTENT OF PROPOSAL
Proposals must be submitted by email to procurement@network180.org. The subject line of the email
must be: Proposal - Independent Review Organization.
Issue Date: June 9, 2026 7

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
The Bidder's email submission must include only the attachments listed below. Bidder must follow the
format and content requirements below to address each item.
A. Vendor Eligibility Form
* Attach one (1) PDF file responsive to Section 4 - Vendor Eligibility/Requirements, using the
template shown in Exhibit B - Vendor Eligibility Application.
* The template is available for download at https://www.network180.org/procurement.
* Name the attachment: [Vendor Name] - Vendor Eligibility Application
B. Services Proposal
* Attach one (1) PDF file containing your services proposal, no longer than 3 pages.
* Name the Word attachment: [Vendor Name] - Services Proposal
* If you are awarded a contract under this RFP, the contents of your services proposal will be
the basis of the contract's Statement of Work.
C. Evaluation Questions and Cost Proposal
* Attach one (1) PDF file containing your responses to the Evaluation Questions and your cost
proposal, using the template shown in Exhibit C - Evaluation Questions and Cost Proposal.
* The template is available for download at https://www.network180.org/procurement.
* Name the attachment: [Vendor Name] - Evaluation Criteria and Cost Proposal
* If you are awarded a contract under this RFP, the contents of your cost proposal will be the
basis of the contract's Compensation Schedule.
* Include all costs, as additional costs not identified in the cost proposal will not be awarded
as part of this procurement.
* Network180 is a tax-exempt organization.
D. References
* Attach one (1) PDF file containing three (3) references from current clients. Clients should be
healthcare organizations which provide similar services to Network180.
* Name the PDF attachment: [Vendor Name] - References
* References must include contact information for the reference, as well as a brief summary
of the type of services performed for the referenced organization.
* References will be checked by Network180.
Please be advised that ALL information submitted in response to public Request for Proposals may be
divulged under the provisions of the Freedom of Information Act (FOIA). Confidential or proprietary
information cannot be shielded from disclosure under the FOIA requirements for a public bid process.
Issue Date: June 9, 2026 8

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
EXHIBIT A - SERVICES AGREEMENT
This Services Agreement ("Agreement") is made between Kent County CMH Authority d/b/a Network180
("Network180"), with a principal place of business at 790 Fuller Ave NE, Grand Rapids, MI 49503, and Vendor Name
("Contractor"), with a principal place of business at Vendor Address, hereby collectively referred to as "Party" or
"Parties."
WHEREAS, Network180 is a Community Mental Health Services Program created to operate, pursuant to 1974 PA
258, the Michigan Mental Health Code, as amended ("Mental Health Code"); and
WHEREAS, Network180 is in need of specific services and Contractor is qualified and willing to provide such services;
and
WHEREAS, Network180 agrees to purchase these services from Contractor according to the terms and conditions in
this Agreement.
NOW, THEREFORE, in consideration of the mutual covenants and conditions contained herein, and for good and
valuable consideration, the sufficiency and receipt of which are hereby acknowledged, and intending to be legally
bound hereby, the Parties agree as follows:
1) Services Performed by Contractor
Contractor agrees to perform Independent Review Organization Services for Network180 as identified in
Attachment A - Statement of Work, which is incorporated in this Agreement by reference.
2) Term
This Agreement will commence on October 1, 2026 and will expire on September 30, 2027, unless amended or
terminated as set forth herein.
3) Compensation Schedule
Contractor will be compensated at the rate of TBD.
4) Total Liability
Network180's total liability to Contractor under this Agreement will not exceed TBD and is subject to
Network180 receiving funds from its funders for such purposes.
5) Invoices and Payments
6) Unless otherwise agreed upon in writing, payment is due thirty (30) days after invoicing. Contractor will submit
monthly invoices to Network180, listing services provided by date, to:
ATTN: TBD
Network180 Accounts Payable
790 Fuller Ave NE
Grand Rapids, MI 49503
accounts.payable@network180.org
7) Insurance Requirements
Contractor will maintain liability insurance in effect during the term of this Agreement, and to provide
Network180 with a certificate evidencing such coverage, at the following minimum coverage levels:
* General Commercial. $1,000,000/occurrence and $2,000,000/aggregate
* Professional (Errors and Omissions). $1,000,000/occurrence and $3,000,000/aggregate
* Privacy and Security (Cyber Security). $1,000,000/occurrence and $1,000,000/annual aggregate; must
cover information security and privacy liability, privacy notification costs, regulatory defense and
penalties, and website media content liability
Issue Date: June 9, 2026 9

Network180 RFP - FY26 IRO - Medical Necessity Consulting/Advisory Services
* Workers' Compensation and unemployment insurance coverage for Contractor's employees. As
required by law; unless Contractor has a valid WC-337 Notice of Exclusion on file with the Michigan
Workers' Compensation Agency or is a sole proprietor within the meaning of the Workers' Disability
Compensation Act of Michigan and has no employees.
8) Quality Assurance
Contractor will perform the services in a timely, professional, safe, and workmanlike manner consistent with
standards in Contractor's trade, profession, or industry; and will meet or exceed the performance and
operational standards and specifications of the Agreement. Contractor will provide all goods and/or services in
good quality, with no material defects, agrees not to interfere with Network180's operations, and will obtain
and maintain all necessary licenses, permits, or other authorizations necessary for performance of the
Agreement.
9) Licensure and Certification
Contractor agrees to maintain in full force and effect any licensing required as a condition of performing services
under this Agreement, and to ensure services will be provided by staff who are licensed or certified under
applicable State statutes, regulations, policies, or guidelines applicable to the delivery of such services under
this Agreement.
Contractor agrees to notify Network180 immediately if any such license, certification, or participation is
hereafter the subject of an investigation or limited, suspended, or terminated for any reason during the term of
this Agreement, or if any State licensure or certification is under investigation at any point during the term of
this Agreement.
10) Criminal Background Checks
Contractor will require and conduct criminal background checks prior to hire, and at least every two years
thereafter, for all persons (staff, management, and non-management) providing services to or interacting with
individuals served by Network180, or all persons (staff, management, and non-management) who have
authority or ability to access or create any financial information or records of individuals served pursuant to this
Agreement.
a) Criminal history checks must be completed through the State of Michigan Licensing Regulator Affairs"
("LARA") Workforce Background Check system (also known as "Rapback"); Internet Criminal History
Access Tool ("ICHAT"), or other service approved by Network180.
b) Contractor will have written procedures in place to respond to criminal history reports.
c) Contractor must notify Network180 immediately if any board member or owner has been convicted
of a felony or misdemeanor related to patient abuse, health care, or any type of fraud, a controlled
substance, or any obstruction of any investigation.
11) Exclusion, Suspension, Debarment
Contractor certifies that it is registered in the System for Award Management (SAM) and has a valid Unique
Entity Identifier (UEI). Contractor further certifies that it is not listed on the government-wide Excluded Parties
List System in SAM.
Federal regulations and State law preclude reimbursement for any services ordered, prescribed, or rendered by
any provider who is currently suspended for terminated from direct or indirect participation in the Michigan
Medicaid program or Federal Medicare program. Contractor must ensure the Exclusion of Certain Persons and
Entities from Participation in Medicare and State Health Care Programs, including Social Security Act Sections
1128, 1128A, 1156; 42 CFR 438.214, 455.100.
Contractor certifies to the best of its knowledge and belief that its board members, owners, and employees, as
applicable:
a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any federal department or contractor;
Issue Date: June 9, 2026 10