2026-36-001 Actuarial Analysis and Consulting Services RFP REVISED.docx

Illinois Department of Healthcare and Family Services Request for Proposal Actuarial Analysis and Consulting Services BidBuy Bid Number: 26-478HFS-MEDPR-B-52728 Agency Reference # 2026-36-001

Section A. SCOPE OF WORK

A.1. OVERVIEW AND PURPOSE

The Department is seeking a Vendor to provide actuarial services, including assistance in the review, advisement, policy support, and development of actuarially sound rates for Managed Care Organizations (MCO) that participate in Illinois Medicaid or related Medical Programs. Vendor will assist in the development of actuarially sound rates and defense of these rates. Vendor shall provide advice, research and counsel about state trends and national developments in Medicaid and Medicare actuarially sound rate development. Vendor shall supply policy advice related to Medicaid and related Medical Assistance programs and policies and evaluate potential future Agency initiatives when needed to support the development of future actuarially sound capitation rate estimates.

A.2. TERM

A.2.1. TERM OF THIS CONTRACT: The contract resulting from this procurement will have an initial term commencing upon the date of last signature of the Parties and ending ten years from execution.

Section B. CURRENT CONDITIONS

B.1. OVERVIEW & BACKGROUND

B.1.1. HFS operates three Medicaid Managed Care programs currently, HealthChoice Illinois, YouthCare and the Medicare-Medicaid Alignment Initiative (MMAI), which cover a collective 3.2 million lives, about 82% of all Illinois Medicaid enrollees. Annually, we work with our actuaries to develop rate certifications for HealthChoice/YouthCare combined, MMAI, Health Benefits for Immigrant Adults, Health Benefits for Immigrant Seniors, and Health Benefits for Immigrant Children. The latter three are split into separate certifications for the federally matchable emergency services and state-funded services.

B.2. VOLUMES & QUANTITIES

B.2.1. Between all the managed care programs, rates are developed annually, and amended as necessary, 54 rate cells across five regions of the state, for a total of 270 rate cells to be developed and maintained. The several managed care programs are at various stages of maturity, with the MMAI program being the oldest, beginning in 2014, and the Health Benefits for Immigrant Adults and Seniors programs beginning in 2024. In recent years the rate certifications have required amendment at least once mid-year, with some certifications having been amended multiple times. Risk adjustment is applied semi-annually. While these make up the bulk of the actuarial work required, there are multiple other projects on which HFS has required assistance from our actuaries over the years as well, such as HCBS waiver renewals and budget neutrality demonstrations, the 1115 waiver rate and program development, and consent decree reporting.

Section C. PROPOSAL REQUIREMENTS

C.1. Only Electronic Submissions through BidBuy of Offers will be Accepted

C.2. REQUIRED DOCUMENTS TO COMPLETE AND SUBMIT

The Offeror shall submit the listed documents in BidBuy under the Attachments tab in the appropriate “Required Attachments” spaces.

C.2.1. Vendor Disclosure or IPG Active Registered Vendor Disclosure C.2.2. Technical response C.2.3. Offer to the State of Illinois C.2.4. Commitment to Diversity Vendor Answer Sheet C.2.5. Business Enterprise Program (BEP) Utilization Plan

C.3. Blank documents may be found on the Chief Procurement Officer for General Service’s website at https://cpo-general.illinois.gov/solicitation-and-contract-templates.html and on the BidBuy posting under “File Attachments:”. Business Enterprise Program/Veterans Small Business Program Utilization Plan may be downloaded from the Commission on Equity and Inclusion’s website at https://cei.illinois.gov/purchasing-entity-resources/compliance.html.

C.4. Failure to submit Vendor Disclosure or IPG Active Registered Vendor Disclosure, as applicable, and the Utilization Plan(s), as applicable, with the Offer submitted in BidBuy shall render the Offer non-responsive.

C.5. Offerors are required to submit their response to the State’s solicitation through BidBuy. Any information sent to the State outside of BidBuy, for example by US Mail, FedEx, UPS, e-mail, or hand delivery, will neither be accepted nor considered. Offeror submissions will only be considered if they are received through BidBuy and on or before the time and date indicated as the “Bid Opening Date” on the BidBuy posting. Any required attachments must be submitted via BidBuy.

C.6. Price entries on the Items tab will be locked automatically upon submission of the quote. Entering cost, pricing or discount information in the Alternate Description may result in disqualification. If the agency requires pricing to be submitted in an attachment, Offeror shall upload pricing under the “Required Documents” section on the Attachments tab and check the box “Does the attachment contain any pricing, cost or discount information?”. Failure to check this box allows your pricing to be viewed when bids are opened and will result in disqualification of your offer. NOTE: Do not check “Does the attachment contain any pricing, cost or discount information” if the attachment does NOT include pricing, cost, or discount information.

C.7. Documents shall be submitted in an electronic format that is accessible and readable using Microsoft Office suite software or Adobe Reader. Corrupted files shall not be considered. It is the Offeror’s responsibility to check that files are accessible and legible after uploading.

C.8. The Offeror is solely responsible for ensuring timely submission of their electronic solicitation response. Failure to allow adequate time prior to the Bid Opening Date to complete and submit a response to a solicitation, particularly in the event technical support assistance from the State is required, places the Offeror and their offer or response at risk of not being accepted.

C.9. The State encourages the Offeror to ensure that their BidBuy account is up-to-date. It is recommended that you access your BidBuy account prior to the solicitation due date and time to make sure that your company’s information is up-to-date and your password is current. Files may be uploaded at any time prior to submission.

C.10. File size may impact the uploading and downloading speed and may lead to browser time-outs, resulting in failed upload/download attempts. Please consider this dependency when attaching very large documents.

C.11. OFFEROR INSTRUCTIONS TO SUBMIT IN BIDBUY

C.11.1. Create Quote:

Note: any pricing entered in the Unit Cost of the Items Tab will be locked until after Technical Evaluations take place. Do not enter cost, pricing, or any discount information in the Alternate Description field. Entering cost, pricing or discount information in the Alternate Description may result in disqualification.

Note: If taking any exceptions to Standard Terms and Conditions an offeror must submit a redline version of the Standard Terms and Conditions with their proposal.

: “Upload” (next to each required attachment) : “Choose File” Note: If a pricing document is required, mark the box next to the question, “Does this attachment contain any pricing, cost, or discount information?”

Failure to mark this box when attaching a pricing document will result in disqualification.

Check this box ONLY if a separate pricing document is required.

Do NOT check this box for any other required quote attachment such as the Technical Proposal, Vendor Disclosure / IPG Active Registered Vendor Disclosure, or Utilization Plan(s), or Offer.

C.11.2. Offerors may also view the “Request for Proposal (RFP) Vendor Submission Instructions Video found at https://cpo-general.illinois.gov/vendor-resources.html

C.12. DUE DATE AND TIME FOR SUBMISSION OF OFFERS

C.12.1. Each solicitation contains the Offer due date and time, appearing as the “Bid Opening Date:” on the BidBuy posting. Offeror shall submit Offers in BidBuy, and the State shall open Offers electronically in BidBuy on the “Bid Opening Date”. The Offer must remain firm for 180 days from opening.

C.13. CONFLICT BETWEEN INFORMATION IN ELECTRONIC DOCUMENTS AND ON BIDBUY

C.13.1. If the State provides information in electronic documents (i.e., the RFP and other attachments) that is different or in conflict with the information the State provides on BidBuy, then the information in electronic documents is presumed to represent the State’s intent. If the Offeror provides information in electronic documents that is different or in conflict with the information the Offeror provides in BidBuy through their Seller Account, then the information in electronic documents shall represent the Offeror’s intended submission.

C.14. PUBLISHED PROCUREMENT INFORMATION

C.14.1. The State publishes procurement information, including solicitations, awards, and amendments, on the Chief Procurement Officer for General Services’ Illinois Procurement Bulletin, known as the Bulletin or BidBuy (https://www.bidbuy.illinois.gov/bso/). Procurement information may not be available in any other form or location. Offeror is responsible for monitoring BidBuy. The State will not be held responsible if Offeror fails to receive the optional e-mail notice of future amendments to the solicitation.

C.15. INFORMATION CONTACT

C.15.1. The individual listed in the “Info Contact:” field on the BidBuy posting shall be the single point of contact for this solicitation. Unless otherwise directed, Offeror should only communicate with the Information Contact. The State/Agency shall not be held responsible for information provided by or to any other person.

C.15.2. Suspected errors should be immediately reported to the Information Contact. Do not discuss, directly or indirectly, the solicitation or any Offer with any State officer or employee other than the Information Contact.

C.16. OFFEROR QUESTIONS AND AGENCY RESPONSE

C.16.1. All questions, other than questions raised at the Pre-Submission Conference, pertaining to this solicitation must be submitted in writing to the Information Contact no later than October 9, 2026. Questions received and Agency responses may be posted as a Bid Amendment to the original solicitation on BidBuy; only these posted answers to questions shall be binding on the State. Offeror is responsible for monitoring BidBuy and BidBuy email notifications.

C.17. PRE-SUBMISSION CONFERENCE

C.17.1. The Agency may conduct a Non-Mandatory Pre-Submission Conference, listed in the “Pre-Bid Conference:” field of the BidBuy posting. Please refer to BidBuy for this information.

C.17.2. If attendance is mandatory, Offeror (current contractor included) will be disqualified and considered non-responsive if Offeror does not attend, is not on time, leaves early, or fails to sign the attendance sheet. Offeror must allow adequate time to accommodate security screenings at the site.

Join from the meeting link https://illinois.webex.com/illinois/j.php?MTID=md874032b00770d51b09b776777f00c4a

Join by meeting number

Meeting number (access code): 2633 525 4002

Meeting password: CTs7mWh2wf2

Join by phone +1-312-535-8110 United States Toll (Chicago) +1-415-655-0002 US Toll

C.18. SMALL BUSINESS SET-ASIDE

C.18.1. In the Bulletin posting, if “Yes” is shown to the question “Is this a Small Business Set-Aside Procurement?”, then Offeror must be registered by the Illinois Small Business Set-Aside Program at the time Offers are due for the Offer to be evaluated. For requirements on qualifying Offeror’s business in the Small Business Set-Aside Program, please go to the Chief Procurement Office for General Service’s website at https://cpo-general.illinois.gov/sell-2-illinois.html.

C.19. BUSINESS ENTERPRISE FOR MINORITIES, WOMEN, AND PERSONS WITH DISABILITIES ACT PARTICIPATION AND UTILIZATION PLAN

C.19.1.2. NIGP codes: 918-04, 918-75, 946-12 C.19.2. Go to https://cei.illinois.gov/vendor-resources/get-bep-certified.html for complete requirements for BEP certification. Go to State of Illinois Commission on Equity and Inclusion at https://supplierdiversitymanagementportal.illinois.gov/home.aspx to search for certified BEP vendors.

C.20. SECURITY

C.20.1. Bid/Performance Bond: N/A. If a bond is required, Offeror must submit the Bid Bond with your offer or Performance Bond to the Information Contact within ten (10) days after contract execution. The bond must be from a surety licensed to do business in Illinois. An irrevocable letter of credit is an acceptable substitute. The form of security must be acceptable to the State.

C.21. TERMS AND CONDITIONS

C.21.1. Standard Terms and Conditions will become a part of any resulting contract. To view the Standard Terms and Conditions, please go to https://cpo-general.illinois.gov/solicitation-and-contract-templates.html.

Section D. EVALUATION PROCEDURES

D.1. EVALUATION PROCESS

D.1.1. The State assesses each Offer for Responsibility (E.10) and Responsiveness. The State considers the information provided and the quality of that information when assessing Offers. If the State finds a failure or deficiency, the State may reject the Offer or reflect the failure or deficiency in the assessment.

D.1.2. There are three scored parts to each proposal – technical, commitment to diversity, and pricing. Each part of the proposal is evaluated and ranked independently of the other parts of the proposal. The results of the evaluation of all three parts shall be used in ranking the proposals.

D.1.3. The State may award to the most responsive and responsible offeror whose offer best meets the specified criteria.

D.2. RESPONSIVENESS

D.2.1. A responsive offeror is one who submits an offer that conforms in all material respects to the Request for Proposal and includes all required forms.

D.2.1.1. The State will determine whether the Offeror complied with the instructions for submitting offers. Except for late submissions, and other requirements that by law must be part of the submission, the State may require that an Offeror correct deficiencies as a condition of further evaluation.

D.2.1.2. Subcontractor Disclosure: If the Offer includes any subcontractors, then Offeror shall complete the Subcontractor Disclosure section of the Offer to the State of Illinois.

D.2.1.3. If completing IPG Active Registered Vendor Disclosure, then responsiveness may include and may not be limited to:

Section D.

D.1.

D.2.

D.2.1.

D.2.1.1.

D.2.1.2.

D.2.1.3.

D.2.1.3.1. Active Illinois Procurement Gateway registration # with expiration date

D.2.1.3.2. Certifications timely to this solicitation

D.2.1.3.3. Disclosure of lobbyists for Offeror and parent entity(ies)

D.2.1.3.4. Disclosure of pending and current contracts

D.2.1.4. If completing Vendor Disclosure, required parts may include and may not be limited to:

D.2.1.4.1. Business and Directory Information: Offeror should complete and return the Business and Directory Information form in Vendor Disclosure, Part 1.

D.2.1.4.2. Illinois Department of Human Rights (IDHR) Public Contracts Number: Offeror shall complete and return the IDHR Public Contracts Number form in Vendor Disclosure, Part 2.

D.2.1.4.3. Authorized to Transact Business or Conduct Affairs in Illinois: A person (other than an individual acting as a sole proprietor) must be a duly constituted legal entity prior to submitting an Offer and authorized to transact business or conduct affairs in Illinois prior to execution of the contract. For more information, see Authorized to Transact Business or Conduct Affairs in Illinois in Vendor Disclosure, Part 3.

D.2.1.4.4. Standard Illinois Certifications: Offeror shall complete and return the Standard Illinois Certifications form in Vendor Disclosure, Part 4.

D.2.1.4.5. State Board of Elections Registration: Offeror may be prohibited from making political contributions and be required to register with the State Board of Elections. For more information, see State Board of Elections in Vendor Disclosure, Part 5.

D.2.1.4.6. Disclosure of Business Operations with Iran: Offeror should complete and return the Disclosure of Business Operations with Iran form in Vendor Disclosure, Part 6.

D.2.1.4.7. Financial Disclosures and Conflicts of Interest: Offeror shall complete and return the Financial Disclosures and Conflicts of Interest form in Vendor Disclosure, Part 7.

D.2.1.4.8. Taxpayer Identification Number: Offeror should complete and return the Taxpayer Identification form in Vendor Disclosure, Part 8.

D.2.2. The State will determine whether the Offer meets the stated Technical requirements. Minor differences or deviations that have negligible impact on the price or suitability of the supply or service to meet the State’s needs may be accepted or corrections allowed. If no offeror meets a particular Technical requirement, the State may waive that requirement.

D.2.3. When the specification calls for “Brand Name or Equal,” the brand name product is acceptable. Other products will be considered with proof that the other product meets stated specifications and is equivalent to the brand product in terms of quality, performance, and desired characteristics.

D.3. EVALUATION METHODOLOGY

D.3.1. The Technical Requirements are described in Sections F.4. The State evaluates the Technical Requirements without consideration of price.

D.3.2. Total Number of Points Available for Technical Requirements is: 1,000

D.3.3. Offeror shall complete and return Sections F.3., F.4.

D.3.4. Relative Weight in Point Format

D.4. COMMITMENT TO DIVERSITY ELEMENTS

D.4.1. Sections 20-15 and 35-30 of the Illinois Procurement Code (30 ILCS 500/) require offerors to be evaluated on their commitment to diversity. The points available for Commitment to Diversity are described in Section F.5. and are equivalent to 20% of the Technical Requirements points. The State evaluates Commitment to Diversity without consideration of price.

D.4.2. The total number of points for Commitment to Diversity is 200.

D.4.3. Offeror shall complete and return Section F.5 Commitment to Diversity.

D.4.4. Commitment to Diversity Categories: The percentages at the end of each section reflect the weighted distribution of points available identified in D.4.1.

Commitment to Diversity Categories

Category 1 – BEP Compliance - Whether the Offeror meets the set goal for contracting or subcontracting with businesses owned by women, minorities, or persons with disabilities or completed a Good Faith Effort Waiver for this procurement. 5%

Category 2 – Subcontracting/Contracting with any WMD businesses (not limited to BEP vendors) - Whether the Offeror has contracted/subcontracted within the prior calendar year with businesses owned by women, minorities, or persons with disabilities. 10%

Category 3 – Diversity, Equity and Inclusion (DEI) Spend – Offeror’s percentage of business, education and/or community spend from prior calendar year gross revenue that involves businesses owned by women, minorities and/or persons with disabilities. The assisted businesses are not required to be certified in the Illinois Business Enterprise Program. 20%

Category 4 – DEI Time - Offeror’s hours spent in the prior calendar year on promoting DEI in the workplace, the community, education institutes, or supporting businesses owned by women, minorities, or persons with disabilities. The assisted business is not required to be certified in the Illinois Business Enterprise Program. The success or failure of each event does not impact the points achieved. The event may be voluntary or paid time. 20%

Category 5 – DEI Policies - The vendor has provided a written copy/screenshot of their current written workforce diversity, equity, and inclusion (“DEI”) policy. The policy provided must be actionable plans, not overarching concepts around DEI. 10%

Category 6 – Diversity in Staffing - % of individuals on governing board and/ or Senior executives who identify as women, minorities or person with disabilities. 10% % of individuals in management /supervisor positions who identify as women, minorities or person with disabilities. 13% % of total staff who identify as women, minorities or person with disabilities. 12%

D.5. MINIMUM REQUIRED POINTS:

D.5.1. Requests for Proposal may specify that offerors must receive a minimum number of points in their Technical and Commitment to Diversity proposals combined to be considered for price evaluation and award.

D.5.2. The State determines how well offers meet the Technical and Commitment to Diversity requirements and rank the offers from best to least qualified using a point ranking system (unless otherwise specified) as an aid in conducting the evaluation. Offerors who receive fewer than the minimum required points will not be considered for price evaluation and award.

D.6. PRICE

D.6.1. The State opens Price proposals after evaluating all Technical and Commitment to Diversity proposals.

D.6.2. If the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State determines whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all price proposals submitted, other known prices, the project budget, and other relevant factors.

D.6.2.1. The total number of points for Price is 240.

D.6.2.2. The State will determine Price points using the following formula:

D.6.2.3. Maximum Price Points X (Lowest Price/Offeror’s Price) = Total Price Points

D.7. MAXIMUM AVAILABLE POINTS

D.7.1. The maximum number of points is 1,000 (Technical) + 200 (Commitment to Diversity) + 240 (Price) = 1,440 maximum available points.

Section E. ADMINISTRATIVE REQUIREMENTS

E.1. GOVERNING LAW AND FORUM

E.1.1. Illinois law and rules govern this solicitation and any resulting contract. Offeror must bring any action relating to this solicitation or any resulting contract in the appropriate court in Illinois. This document contains statutory references designated with “ILCS”. To view the full text, go to https://ilga.gov/Legislation/ILCS/Chapters . The Illinois Procurement Code (30 ILCS 500) and the Standard Procurement Rules (44 ILL. ADM. CODE PART 1) are applicable to this solicitation. To view them respectively, go to and Illinois General Assembly - ADMINISTRATIVE CODE.

E.2. PUBLIC RECORDS AND REQUESTS FOR CONFIDENTIAL TREATMENT

E.2.1. Offers become the property of the State. All offers will be open to the public under the Illinois Freedom of Information Act (FOIA) (5 ILCS 140) and other applicable laws and rules, unless Offeror requests in its Offer that the State treat certain information as confidential. A request for confidential treatment will not supersede the State’s legal obligations under FOIA. The State will not honor requests to keep entire Offers confidential. Offerors must show the specific grounds in FOIA or other law or rule that support confidential treatment. Regardless, the State will disclose the successful Offeror’s name, the substance of the Offer, and the price.

E.2.2. If Offeror requests confidential treatment, Offeror must submit additional copy/copies (see Instructions for Submission of Offers in Section C.) of the Offer with proposed confidential information redacted. This redacted copy must tell the general nature of the material removed and shall retain as much of the Offer as possible. In a separate attachment, Offeror shall supply a listing of the provisions identified by section number for which it seeks confidential treatment and identify the statutory basis or bases under Illinois law, including a detailed justification for exempting the information from public disclosure.

E.2.3. Offeror will hold harmless and indemnify the State for all costs or damages associated with the State defending Offeror’s request for confidential treatment. Offeror agrees that the State may copy the Offer to facilitate evaluation, or to respond to requests for public records. Offeror warrants that such copying will not violate the rights of any third party.

E.3. MINORITY CONTRACTOR INITIATIVE

E.3.1. The State requires a fee of $15 to cover expenses related to the administration of the Minority Contractor Opportunity Initiative. Any offeror awarded a contract of $1,000 or more under Section 20-10, 20-15, 20-25 or 20-30 of the Illinois Procurement Code (30 ILCS 500) is required to pay a fee of $15. The Comptroller shall deduct the fee from the first check issued to the Vendor under the contract and deposit the fee in the Comptroller’s Administrative Fund. 15 ILCS 405/23.9.

E.4. FEDERAL FUNDS

E.4.1. The resulting contract may be partially or totally funded with Federal funds. Upon notice of intent to award, the percentage of supplies and/or services involved that are Federally funded and the dollar amount of such Federal funds will be disclosed.

E.5. EMPLOYMENT TAX CREDIT

E.5.1. Offerors who hire qualified veterans and certain ex-offenders may be eligible for tax credits. 30 ILCS 500/45-67 and 45-70. Please contact the Illinois Department of Revenue (217-524-4772) for information about tax credits [35 ILCS 5/216, 5/217].

E.6. RESERVATIONS

E.6.1. Offeror must read and understand the solicitation and tailor the Offer and all activities to ensure compliance. The State reserves the right to amend the solicitation, reject any or all offers, award by item/services, group of items/services, or grand total, and waive minor defects. The State may request a clarification, inspect Offeror’s premises, interview staff, request a presentation, or otherwise verify the contents of the Offer, including information about subcontractors and suppliers. The State may request Best & Final Offers when appropriate. The State will make all decisions on compliance, evaluation, and terms and conditions, and shall make decisions in the best interests of the State and in accordance with the Illinois Procurement Code, rules and other applicable State and Federal statutes and regulations. This competitive process may require that Offeror provide additional information and otherwise cooperate with the State. If an offeror does not comply with requests for information and cooperate, the State may reject the offer as non-responsive to the solicitation. Submitting an offer does not entitle Offeror to an award or a contract. Posting a vendor’s name in a Bulletin notice does not entitle the vendor to a contract. The State is not responsible for and will not pay any costs associated with the preparation and submission of any offer.

E.6.2. Awarded Offeror(s) shall not commence and will not be paid for any billable work undertaken prior to the date all parties execute the contract, unless approved in writing in advance by the State Purchasing Officer or the Chief Procurement Officer (or designee).

E.7. AWARD

E.7.1. The State is not obligated to award a contract pursuant to this solicitation. If the State issues an award, the award will be made to the responsive and responsible offeror whose offer best meets the specified criteria unless otherwise permitted by the Illinois Procurement Code and Illinois Administrative Code. However, if the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, then the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State will determine whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all prices submitted, other known prices, the project budget and other relevant factors. The State will post a notice to the Bulletin identifying the apparent most responsive and responsible offeror.

E.8. INVOICING ADDRESS

E.8.1. The awarded Vendor shall invoice at the completion of the contract unless invoicing is tied in the contract to milestones, deliverables, or other invoicing requirements agreed to in the contract. The Bulletin posting contains the “Bill-to Address:” where invoices should be sent.

E.8.1.1. Invoice Submission: The Vendor shall submit invoices on a monthly basis, no later than the 10th day of the following month, for services rendered during the preceding month. All invoices shall be submitted electronically to HFS at Don.Beers@illinois.gov.

E.8.1.2. Invoice Content: Employee Name, Employee Position Name, Number of Hours Worked, Hourly Rate for Each Position, Total Amount due for Each Position and Summary of Projects Worked.

E.8.1.3. BEP Spend: The Vendor shall submit documentation that supports the BEP spend on a monthly basis, no later than the 10th day of the following month.

E.8.1.4. Compliance with Payment Terms: Invoices that do not include the required details or fail to comply with the contractual terms shall be returned to the Vendor for revision and resubmission. The Agency reserves the right to withhold payment until a proper invoice is received.

E.8.1.5. Project Tracking: The Vendor shall ensure that invoicing aligns with the work performed and documented in any required progress reports or time-tracking systems. The Agency reserves the right to request additional supporting documentation to verify work performed.

E.8.2. Vendor shall not bill for any taxes unless accompanied by proof that the State is subject to the tax. If necessary, Vendor may request the applicable Agency’s Illinois tax exemption number and Federal tax exemption information.

E.9. PROTEST REVIEW OFFICE

E.9.1. Offeror may submit a written protest to the Protest Review Office following the requirements of the Standard Procurement Rules. 44 ILL. ADM. CODE 1.5550. For protests related to specifications, the Protest Review Office must physically receive the protest no later than fourteen (14) days after the solicitation or related addendum was posted to the Bulletin. For protests related to rejection of individual proposals or awards, the protest must be received by close of business no later than fourteen (14) days after the protesting party knows or should have known of the facts giving rise to the protest. The Protest Review Office’s information is as follows:

Chief Procurement Office Attn: Protest Review Office Email: cpogs.pro@illinois.gov

E.10. RESPONSIBILITY

E.10.1. A responsible Offeror is one who has the capability in all respects to perform fully the contract requirements and who has the integrity and reliability that will assure good faith performance. The State determines whether the Offeror is a “responsible” offeror; an offeror with whom the State can or should do business. For example, the State may consider the following:

E.10.2. A “prohibited bidder” includes any person assisting an employee of the State of Illinois by reviewing, drafting, directing, or preparing any invitation for bids, a request for proposal, or request of information, or providing similar assistance unless such assistance was part of a publicly issued opportunity to review drafts of all or part of these documents. For purposes of this section, an employee of the State of Illinois means one who, by the nature of his or her duties, has the authority to participate personally and substantially in the decision to award a State contract. No person or business shall submit specifications to a State agency unless requested to do so by an employee of the State. No person or business that contracts with a State agency to write specifications for a particular procurement need shall submit a bid or proposal or receive a contract for that procurement need.

E.10.3. Nothing herein is intended to prohibit a vendor from bidding or offering to supply developing technology, supplies or services after providing the State with a demonstration of the developing technology, supplies, or services; provided the subject of the demonstration to the State represents industry trends and innovation and is not specifically designed to meet the State's needs. Nothing herein is intended to prohibit a person or business from submitting a bid or offer or entering into a contract if the person or business: (i) initiates a communication with an employee to provide general information about products, services, or industry best practices and, if applicable, that communication is documented in accordance with Section 50-39 of the Illinois Procurement Code or (ii) responds to a communication initiated by an employee of the State for the purposes of providing information to evaluate new products, trends, services, or technologies.

E.10.4. Other factors that the State may use to evaluate to determine responsibility include, but are not limited to: political contributions, certifications, conflict of interest, financial disclosures, taxpayer identification number, past performance in business or industry, references (including those found outside the Offer), compliance with applicable laws, financial responsibility, insurability, effective equal opportunity compliance, payment of prevailing wages if required by law, capacity to produce or sources of supply, and the ability to provide required maintenance service or other matters relating to the offeror’s ability to deliver in the quality and quantity within the time and price as specified in this solicitation.

E.10.5. Awarded offerors must always have financial resources sufficient, in the opinion of the State, to ensure performance of the contract and must provide proof upon request. The State may require a performance bond if, in the opinion of the State, it ensures performance of the contract. The State may terminate the contract, consistent with the termination for cause provision of the contract, if the vendor lacks the financial resources to perform under the contract.

E.10.6. The State may require that an offeror correct any deficiencies as a condition of further evaluation.

E.11. BidBuy Terminology and Guidance: BidBuy is an online e-procurement system. There may be some difference between the procurement terminology used in this solicitation and the terms used in BidBuy. Please learn more about BidBuy by accessing the online resources found here: https://pathway2procurement.illinois.gov/bidbuy.html

Section F. PROPOSAL FORMS

F.1.2. Commitment to Diversity (Section F.5)

F.1.3. Offer to the State of Illinois

F.2. CONTRACT REQUIREMENTS: Please read each contract requirement carefully in F.2. These contract requirements shall be included in any contract resulting from this solicitation.

F.2.1. Expert Testimony: At the request of the Department, Vendor shall provide the Department with expert testimony in court and before administrative bodies, including, but not limited to, the justification of Medicare and Medicaid rates before Federal CMS or MCO(s).

F.2.2. Reporting and File Maintenance: Vendor shall develop and maintain all reporting and file maintenance requirements established by the Department, including electronic data processing. For the purposes of reporting and file maintenance, Vendor must receive and return large volumes of detailed claims data. Vendor must accept these data files, store information appropriately, and transfer the data back to the Department in a secure environment. The secured data environment must include either a secured web-based exchange or encrypted hardware/software capability that requires password protection.

F.2.3. Vendor shall be readily available to the Department for services on an “on-call” basis during regular business hours, from 8:00 a.m. to 5:00 p.m. Central Standard Time Monday through Friday, excluding State holidays. Upon request by the Department, the Vendor shall attend meetings at the Vendor’s expense. Meetings will be held at the Department’s business offices in Chicago, Illinois or Springfield, Illinois. The Department will make every effort to provide at least one week’s notice for on-site meetings. It is estimated that the Vendor may be expected to be on-site for three (3) trips per contract year, with each trip lasting approximately two (2) days. The Vendor shall be solely responsible for all travel-related expenses incurred while performing services under this contract.

F.2.4. Vendor shall consult on other complex actuarial matters the Department might request from time to time over the term of the contract, which matters are reasonably within the scope of the contract but not specifically contemplated within this RFP. Such additional projects shall be presented in writing by the Department and a scope of work agreed upon with Vendor, subject to approval of the Department and in accordance with Illinois Procurement Code and Rules.

F.2.4.1. Work Order Process:

1. The Agency will issue a Scope of Work specific to the contract scope of the project for those services described in the resulting contract. The Agency will request that the Vendor prepare and submit a detailed Cost Package and schedule for the completion of the work described in the Scope of Work. The Cost Package will become effective and considered a part of the contract upon approval by the Agency's written Work Order (Attachment 6).

2. Cost Package: At a minimum, the Cost Package shall include and detail the work to be performed by the Vendor and a schedule for the performance of the work. The Cost Package shall be all-inclusive and shall consist of and detail labor rates and all respective hours. Costs submitted in the Cost Package must be reflective of the costs identified in the contract. The Vendor shall identify in their cost package all assigned personnel for the respective project and all subcontractors. The Agency shall be notified in advance of all Vendor staffing changes, substitutions, or replacements and subcontractor changes. The Agency must approve these changes in writing prior to the changes taking effect, such changes will be accomplished through the Work Order Amendment form (Attachment 7).

3. Work Order: Upon approval of the Cost Package, the Agency will provide written authorization to initiate the activities in the Scope of Work, in the form of a Work Order. Each Work Order will identify the Agency's authorized representative(s) for each respective project. A Work Order is a document signed by Agency Authorized Representative(s) requiring the Vendor to perform the tasks in the applicable Work Order and the total dollar amount for the work. Each Work Order shall become an integral and enforceable part of the Contract once executed by the Agency. All provisions of the Contract are applicable to Work Orders unless the context clearly indicates otherwise. The Vendor shall not begin work until the Vendor has received an executed Work Order from the Agency. Work Orders shall be issued at the Agency's discretion.

4. The Agency’s designee will be identified in each project or task's scope of work, which will become a part of the contract. The PM is not authorized to make any commitments or authorize any changes which affect the contract price, labor rates, terms, or conditions of this contract as a work order. Any such proposed changes shall be submitted to the Agency by the Vendor in a formal written Work Order Amendment form (Attachment 7) for consideration by the Agency.

5. Stop Work Order: The Agency shall issue a Stop Work Order if it is determined that the work is no longer needed, or for any other reason the Agency deems necessary. Work authorized under the terms of the Work Order shall stop. The Agency will determine the terms of the Stop Work Order, such as determining how quickly to shut down work, demobilization time frames, and completion of any necessary work. The Vendor shall immediately comply with the terms of the Stop Work Order, which may include steps to leave the site. The Vendor shall be paid for charges properly invoiced for all work satisfactorily completed up to the time when the Stop Work Order's terms are completed.

F.2.5. Vendor shall provide actuarial analysis and consulting services to advance the State's Medicaid Section 1115 Healthcare Transformation Waiver implementation.

F.2.6. Vendor shall provide actuarial analysis and consulting services to inform a Tailored Care Management Program (TCMP).

F.2.7. Vendor shall provide actuarial analysis and consulting services to support the development of the Department’s Transforming Maternal Health (TMaH) Model.

F.2.8. Vendor shall provide reporting and analytical solutions that answer actuarial questions presented by the Department.

F.2.9. Vendor shall comply with and execute the HIPAA Business Associate Agreement (Attachment 4).

F.2.10. Expert Comparative Assistance: Vendor shall provide the Department with expert comparative state information and developments that might be helpful to the Department on significant and relevant actuarial issues that might arise during the term of the contract.

F.2.11. As requested by the Department, Vendor shall provide the Department with all reports, data sets, documents and analysis used in setting the capitation rates.

F.2.12. Vendor shall perform any analysis or rate models requested by the Department to quantify the effect of proposed changes to policies regarding payment rates, covered services, or other proposed program changes.

F.2.13. In the case of an audit, Vendor shall document and justify all work related to capitation rate development.

F.2.14. Vendor shall assist the Department in developing processes to monitor encounter data for accuracy and completeness.

F.2.14.1. Vendor shall collect encounter data and review submitted encounter data to ensure completeness and accuracy in conjunction with HFS encounter data team.

F.2.14.2. Vendor shall conduct monthly evaluations of volumes and expenditures upon receipt of enrollment and encounter data and identify potential discrepancies.

F.2.14.3. Vendor shall submit evaluation of encounter data including completeness and trending utilization, no later than 20 business days following the end of the month in which the encounter data was due from the MCO.

F.2.14.4. Quarterly reports comparing the health plan submitted encounter data with self-reported financial and utilization data is due no later than the fifth month following the end of each State fiscal year quarter or as mutually agreed upon by the Department and the Vendor.

F.2.15. Vendor shall assist the department in developing actuarially sound capitation rates for Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP).

F.2.16. Vendor shall assist the department in developing actuarially sound capitation rates for Program of All-Inclusive Care for the Elderly (PACE).

F.2.17. Vendor shall assist the Department in developing Annual renewal of Long Term Supports and Services (LTSS) rates for Medicare/Medicaid dual eligible opting out of MMAI and selection adjustment of LTSS rates.

F.2.18. Vendor shall assist the Department in developing Annual renewal of HealthChoice Illinois (HCI) rates and risk adjustment of HCI rates consistent with 42 CFR part 438 and relevant Actuarial Standards of Practice (ASOPs).

F.2.19. Vendor shall assist the Department in developing Annual renewal of Health Benefits for Immigrant (HBI) rates and risk adjustment of HBI rates consistent with 42 CFR part 438 and relevant ASOPs.

F.2.20. Vendor shall assist the Department in developing Annual renewal of DCFS Youth rates and risk adjustment of DCFS Youth rates consistent with 42 CFR part 438 and relevant ASOPs.

F.2.21. Vendor shall assist the Department in developing initial and annual review of new populations as required by the Department.

F.2.22. Performance Requirements. Vendor shall devote the necessary resources to ensure a timely response to consulting requests from the Department. A timely response will be determined between the Department and Vendor at the time each request is made.

F.2.22.1. Status Report and Reporting Procedures. The Vendor shall submit weekly status reports to the State and others as requested regarding the progress of each Work Order approved by the State.

F.2.22.2. Monthly Status Reporting.

1. Maintain and deliver a list of contract deliverables and provide a monthly status of each item to support the invoice approval process.

2. Submit monthly status reports as designated by the State, including but not limited to:

F.2.22.2.2.1. Progress against schedule including upcoming and past-due milestones, risks and issues and decisions.

F.2.22.2.2.2. Additional status materials where needed to facility status reviews.

F.2.23. Reporting:

F.2.23.1. Central Repository – The Vendor shall maintain the assigned HFS SharePoint and or State-designated successor sites for the Program on a weekly basis. The SharePoint or successor site shall be maintained in such a way that allows for the quick retrieval of documentation.

F.2.23.2. Report Format – The Vendor shall provide reports in an easily accessible and modifiable State-approved format that will allow for ongoing revision and maintenance.

F.2.23.3. Report Quality – The Vendor shall propose a reports quality assurance program that ensures that new or modified documentation is complete, accurate, meets the State’s needs, and can be approved in a timely manner.

F.2.23.4. Reporting Timeliness – The Vendor shall provide reporting on an approved schedule according to applicable Service Level Agreements (SLAs).

F.2.23.5. Deliverable Review Period – The Vendor shall adhere to a 10-5-10 review schedule for new or updated deliverables, with the State having 10 business days for initial review, the Vendor having 5 business days to respond to State comments, and the State having 10 business days to review Vendor’s response, with the 5-business-day cycles repeating until all open comments are resolved. For deliverables that are lengthy or more complex, the State and Vendor will agree to a review schedule that allows adequate time for comprehensive review and revision.

F.2.23.6. Vendor shall provide policy advice related to Medicaid and related Medical Assistance programs and policies and evaluate potential future Agency initiatives when needed to support the development of future actuarially sound capitation rate estimates.

F.2.24. MILESTONES AND DELIVERABLES:

F.2.24.1. Deliverables and reports that the Vendor must produce as part of this contract are contained in the requirements in Section F. A summary of deliverables and reports are available in Attachment 1 – Required Deliverables and Reporting as a convenience.

F.2.25. SERVICE LEVEL AGREEMENTS (SLAs):

F.2.25.1. The State has established the following service levels for Vendor performance. The State will review with the Vendor all SLAs to describe measurement calculation and set baseline metrics upon contract execution.

F.2.25.2. On a monthly basis, no later than the 10th business day of the month following the reporting month, the Vendor shall provide the State an SLA Dashboard which includes a scorecard of all SLA compliance levels and a written explanation of each occurrence where an SLA was not met. The State may request a meeting to discuss issues related to the SLA Dashboard.

F.2.25.3. For each missed SLA, no later than 10 business days following the delivery of that month’s SLA Dashboard, Vendor shall provide a CAP that describes:

1. The missed SLA

2. Specific cause of the problem

3. The solution

4. How the Vendor will avoid missing the SLA in the future.

F.2.25.4. Service Levels

Administration Fees at Risk

General