SOLICITATION BUDGET: $4,000,000.00
SOLICITATION POSTING DATE: 11/20/2024
RESPONSE DUE DATE: 1/23/2025

Purpose and Objectives
The Washington State Health Care Authority, hereafter called “HCA,” is initiating this Request for Proposals (RFP) to solicit Proposals from qualified Bidders interested in serving as the Third-Party Administrator (TPA) for HCA’s Reentry Demonstration Initiative (Initiative). A copy of the Medicaid Transformation Project 2.0 (MTP 2.0) waiver and related documents can be found at Medicaid Transformation Project (MTP) | Washington State Health Care Authority. 
HCA seeks a Bidder to partner with HCA, Carceral Facilities, carceral providers, Tribal Governments, Community-Based Organizations (CBOs), MCOs, and other non-traditional medical providers to provide Technical Assistance (TA)  to Carceral Facilities to support the implementation of the Initiative for the Apple Health reentry population.

The objectives of the Initiative include:
1.    Improving health outcomes and reducing recidivism (re-offense), emergency department visits, overdoses, and death. 

2.    Supporting case management and Substance Use Disorder (SUD) treatment and recovery and prevention and treatment of targeted infectious diseases like Hepatitis C before a person’s release.

3.    Stabilizing and treating other conditions before a person’s release, so they can reenter their community as healthily as possible. 

HCA’s main goal with the Initiative is to reduce mortality, morbidity, and recidivism and to improve health among Apple Health Enrollees who are incarcerated. 
This procurement seeks to award one contract to a TPA responsible for providing participating facilities, partners, and providers in implementing and administering the Initiative. The TPA will support the clinical and social care of Apple Health Fee-for-Service Enrollees and managed care Enrollees as described in this RFP. Any contract awarded as a result of this procurement is contingent upon the availability of funding and final approval of the relevant protocols by the Centers for Medicare and Medicaid Services (CMS).

Minimum Qualifications
The following are the minimum qualifications for Bidders:
1.    Must be licensed to do business in the state of Washington and has been issued a Washington State Unified Business Identifier (UBI) number or provide a commitment that it will become licensed in Washington within thirty (30) calendar days of being selected as the ASB.

2.    Five (5) years of experience working with Medicaid programs and performing Medicaid claims payment in a HIPAA compliant format.

3.    If not already located in Washington State, Bidder must provide a commitment that it will establish a regional office facility in the state of Washington within the first ninety (90) days of signed Contract .

4.    Must have demonstrated capability to analyze and report data at regular intervals and make recommendations as to improvement strategies for cost and utilization.

5.    Must comply with all HCA and Washington state Office of Insurance Commission (OIC) regulations related to individual complaints and appeals processes.

6.    Must comply with all Washington Technology Solutions (WaTech) Security Standards and Policies.

7.    Must agree to complete and pass a Security Design Review by the Complete Security Design Review date provided in Section 1.2, (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES). 

8.    Must comply with all state and federal privacy and security laws, statutes and regulations for protecting Apple Health Enrollee data, including HIPAA. Bidder must require all Subcontractors to implement these safeguards.

9.    Must have program integrity policies and procedures addressing fraud, waste, and abuse, including detection and prevention, or provide a commitment that it will establish Program Integrity policies and procedures by the Implementation of TPA Services date provided in Section 1.2, (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES).

10.    Must have Quality Management Plan and Performance Improvement policies and procedures addressing quality and appropriateness of care and services and promoting improved patient outcomes through monitoring and evaluation activities, or provide a commitment that it will establish Quality Management Plan and Performance Improvement policies and procedures by the Implementation of TPA Services date provided in Section 1.2, (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES).

11.    Meet an AM Best financial rating score of A- or better at the time of Proposal submittal.

12.    Must have the ability to accept and process appropriate HIPAA transactions (including 834 and 837) from ProviderOne in order to confirm client eligibility and report encounters.
 

Find the full solicitation on Washington’s Electronic Business Solution (WEBS). Vendors not registered in WEBS will not receive updates or amendments to the solicitation, which may put them at a disadvantage.