Description
This solicitation (RFP 112209 O3) seeks a single award to operate Nebraska’s full‑risk, capitated Medicaid Managed Care program covering physical health, behavioral health, pharmacy, and dental services for all state Medicaid members. The contract is a five‑year base term with the possibility of two one‑year renewal options. Key elements include:
• Mandatory pre‑proposal conference (April 28 2022) and a strict bid‑submission deadline (July 1 2022, 2 pm CT).
• Full‑risk financial responsibility: the MCO receives per‑member capitation payments, must meet medical‑loss‑ratio and quality‑performance thresholds, and is subject to hold‑back and liquidated‑damage provisions.
• Extensive performance metrics (QPPs) covering claims timeliness, encounter acceptance, appeal resolution, preventive‑care screenings, chronic‑disease management, substance‑use‑disorder treatment, and readmission monitoring, each tied to a percentage of the payment pool.
• Optional fee‑for‑service component (Section AA) that allows the State to procure separate claims‑processing services.
• Detailed reporting, data‑exchange, and audit requirements, with all non‑proprietary proposals becoming public record.