The time table is that the final draft of the recommended managed care RFP language is November 1, 2018 unless otherwise agreed. This will include a white paper detailing all recommendations: December 1, 2018 written recommendations on national Best Practices for legislative or interagency communications and collaborations; February 1, 2019 white paper detailing all recommendations for review and recommendation for fee-for-service and foster care population; May 1, 2019 written recommendations due on DMS policies and procedures on reporting requirements and written recommendations on DMS capacity building structure.
On April 16th, the Cabinet for Health and Family Services (“CHFS”), on behalf of the Department for Medicaid Services (“DMS”), issued an RFP for a consultant to perform a comprehensive review and evaluation of DMS’ Medicaid Managed Care (“MCO”) Program. Presumably this will be used when the RFP for the MCOs is issued. Based on the timeline in this RFP, it looks like the MCO RFP will be issued next year.
The review is to include current MCO contractual requirements and performance as well as substantive recommendations for the upcoming RFP. Included in the activities are: a review of current contracts and comparison against national best practices; high level assessment of draft actuarial assumptions for rates; development of a comprehensive case management plan including performance benchmarks and outcome measurables; the identification and outline of nationwide MCO sanctions and penalties; advise DMS on strategic opportunities. The contractor will also assess DMS’ current financial management of MCOs and advise DMS and its actuaries on financial best practices which will have an immediate impact on MCO capitation payments, enable better financial performance and sustain future program efficiency. The contractor will provide support to CHFS Information Technology / Analytics Team; advise DMS on best practices in the transparency of contractor and subcontractor benefit administration; review past MCO performance, improvement projects and provide recommendations on national best practices specifically with regard to the Commonwealth’s needs based on current health statistics. The contractor will also assist in the development of key health care outcomes to be delivered in accordance with national best practices including pilot projects and ongoing benchmarks. Community outreach and health project goals will be addressed as well as advising DMS on estimated cost and implementation issues. The contractor will also develop robust provider network adequacy reports and assessment tools and define full-time FTEs needed to better analyze access and availability for the Medicaid population.
Fee-for-service and foster care populations will be reviewed and opportunities identified to carve into the managed care system and provide an outline for the implementation process.
The contractor will also assist with current MCO performance management and assist DMS to define and develop programs to ensure total cost efficiency, establishment of safeguards.
October 31, 2018 - RFP language final draft
October 31, 2018 - Main White Paper
November 30, 2018 - National Legislative / Agency Collaboration Best Practices
January 31, 2019 - Waiver carve in white paper
February 28, 2019 - DMS policies and procedures recommendations
April 30, 2019 - DMS capacity building structure recommendations
QUESTIONS REGARDING RFP?
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