26-RFI-21377 - State Medicaid Data Analytics and Oversight Solutions.pdf

Department of Human Services

State Medicaid Data Analytics & Oversight Solutions

Request for Information (RFI)

26-RFI-21377

Date: October 5, 2026

State Medicaid Data Analytics & Oversight Solutions Request for Information October 5, 2026

Table of Contents

PART 1. GENERAL INFORMATION

1.1 Purpose of this Request for Information

1.2 Request for Information Timeline

1.3 Disclaimers

PART 2. BACKGROUND

2.1 Background Information

PART 3. REQUEST FOR INFORMATION SUBMISSION FORMAT

3.1 Response Submission

3.2 Cover Letter

3.3 Conceptual Solutions and Strategies Response

3.3.1 Organizational Experience

3.3.2 Innovative Solutions & Emerging Practices

3.3.3 Data Analytics & Financial Transparency

3.3.4 Medical Economics & Priority Service Categories

PART 1. General Information

1.1 Purpose of this Request for Information

The Pennsylvania Department of Human Services (“Department”), Bureau of Procurement & Contract Management issues this Request for Information (“RFI”) to gather input and information concerning innovative solutions that leverage Medicaid data to improve transparency within Pennsylvania’s Medicaid managed care delivery system and strengthen the Department’s ability to make evidence-based rate-setting decisions.

Specifically, this RFI seeks information regarding innovative analytical methodologies, technologies, and strategies that transform existing Medicaid data into actionable insights by improving visibility into organizational structures, ownership and affiliations, financial and reimbursement flows, utilization patterns, and other factors that influence Medicaid expenditures and future rate-setting methodologies. The Department is interested in approaches that examine relationships among Managed Care Organizations (“MCO”), county Primary Contractors, affiliated entities, subcontractors, providers, vendors, service brokers, and other entities participating in the Medicaid managed care delivery system.

Through this RFI, the Department seeks to better understand innovative approaches that strengthen managed care oversight, improve financial transparency, and support evidence-based policy, procurement, and future rate-setting decisions. The Department welcomes both enterprise-wide and targeted solutions applicable across the Medicaid managed care delivery system, as well as approaches focused on service categories experiencing significant utilization or expenditure growth, including, but not limited to, Applied Behavior Analysis (“ABA”), Pharmacy Services, Long-Term Care (“LTC”), and Home and Community-Based Services (“HCBS”).

The Department encourages vendors and other interested parties to provide feedback in response to this RFI or any part thereof (referred to as “respondents” for the purposes of this RFI).

A respondent may address all or any of the specific questions or topics included in this RFI.

1.2 Request for Information Timeline

Event Date Release RFI October 5, 2026 Vendor RFI Responses Due November 13, 2026

The Department is requesting that all responses to this RFI be submitted by 12:00 p.m. on the due date. Responses must be submitted electronically to the following email account with “State Medicaid Data Analytics & Oversight Solutions RFI” in the email subject line: RA-

PWRFICOMMENTS@PA.GOV .

mailto:RA-PWRFICOMMENTS@PA.GOV

While the Department does not intend to respond to questions or clarifications during the RFI response period, respondents may submit administrative questions related to this RFI electronically to: RA-PWRFICOMMENTS@PA.GOV using “State Medicaid Data Analytics & Oversight Solutions RFI question” in the email subject line. The Department may or may not respond based on the nature of the question. The Department will post all answers provided online at: http://www.emarketplace.state.pa.us.

1.3 Disclaimers

The Department is not liable for any costs or expenses incurred by vendors in the preparation of responses related to this RFI.

This RFI is issued for information and planning purposes only and does not constitute a solicitation for future business, an offer for procurement, or any other type of current or future procurement action and is only intended to gather information and input. The Department will not award an agreement on the basis of this RFI or otherwise pay for any of the information received.

The Department may use the information gathered through this process in the development of future procurement documents; however, the Department does not guarantee that this will occur.

The Department will not return responses to this RFI. Respondents will not be notified of the result of the review, nor will they be provided copies of it. If the Department issues a procurement document, no vendor will be selected, pre‐qualified, or exempted based on its participation in this RFI process.

Respondents should be aware that the responses to this RFI will be public information and that no claims of confidentiality will be honored. The Department is not requesting, and does not require, confidential, proprietary information, or other competitively sensitive information to be included as part of the RFI submission. Ownership of all data, material and documentation originated, prepared, and provided to the Department during this RFI process will belong exclusively to the Department.

PART 2. Background

2.1 Background Information

The Department administers Pennsylvania’s Medicaid managed care programs through contracts with MCOs and county Primary Contractors serving diverse populations across physical health, behavioral health, long-term care, home and community-based services, and other Medicaid programs (including, but not limited to, the Program of All-Inclusive Care for the Elderly (“PACE”).

As Medicaid managed care continues to evolve, the Department recognizes opportunities to leverage innovative analytical approaches to improve transparency, strengthen oversight, and http://www.emarketplace.state.pa.us/ better inform managed care rate setting. Medicaid services may be delivered and financed through complex organizational and contractual relationships involving MCOs, Primary Contractors, parent and affiliated entities, subcontractors, providers, vendors, service brokers, and other organizations. Greater visibility into these relationships and associated financial and reimbursement flows may provide additional insight into the factors influencing Medicaid expenditures and program performance.

The Department currently uses and has access to a variety of data to support program administration, oversight, and rate setting, including, but not limited to, ownership and affiliation information, financial and operational data, claims and encounter data, provider data, utilization data, and information related to value-based payment and other incentive arrangements. The Department is interested in understanding how these and other available data sources can be integrated and analyzed to identify organizational relationships, funding and reimbursement flows, utilization and expenditure trends, and emerging cost drivers.

Through this RFI, the Department seeks to better understand current industry capabilities, emerging technologies, and innovative practices that can transform existing data into actionable insights. The Department is particularly interested in approaches that identify meaningful patterns across entities and service categories and translate analytical findings into practical strategies for oversight, policy development, procurement, and future rate-setting decisions.

PART 3. Request for Information Submission Format

Through this RFI, the Department is soliciting information and comments regarding innovative State Medicaid data analytics and oversight solutions. All interested parties are asked to respond in writing to this RFI, per the items outlined below.

3.1 Response Submission

Please prepare responses simply, providing straightforward and concise language and descriptions. All responses should be produced in 12 point font. Please limit your response to no more than 10 pages, not including the cover letter or attachments. Please refrain from sending marketing materials to the Department.

3.2 Cover Letter

Please include a cover letter with the following information:

1. An introduction to the respondent’s organization, background, and interest in State Medicaid data analytics and oversight solutions.

2. General information about the respondent and respondent organization, including an address and a point of contact along with a telephone number and an e-mail address.

3. A description of the respondent’s organizational structure, ownership and affiliations, and any actual or potential conflicts of interest arising from relationships with MCOs, Primary Contractors, affiliated entities, subcontractors, providers, vendors, or other entities doing business with state Medicaid programs.

3.3 Conceptual Solutions and Strategies Response

The following provides a suggested structure for a response to this RFI. This structure is intended to minimize the effort required to develop and analyze submitted responses. Please address the following, as relevant:

3.3.1 Organizational Experience

(a) Provide an overview of your or your organization’s experience and knowledge related to state Medicaid operations, monitoring and oversight, medical economics, data analytics, and financial evaluation, or other related areas. Respondents may also include any relevant experience in governmental health care rate-setting, financial oversight, or insurance regulatory activities, that may offer approaches transferable to Medicaid.

3.3.2 Innovative Solutions & Emerging Practices

(a) Describe innovative analytical approaches, oversight strategies, or business practices that state Medicaid agencies should consider implementing to improve financial transparency, managed care oversight, and rate-setting decision making. Identify emerging trends, risks, opportunities, or industry practices that state Medicaid agencies should be aware of over the next three to five years.

(b) Describe innovative methodologies, technologies, or data sources that can provide actionable insights beyond traditional financial, claims, encounter, or actuarial reporting.

Include any data or information that states may not traditionally use but should consider incorporating into their analytical and oversight activities.

(c) Identify successful practices, analytical approaches, or innovative solutions implemented by other state Medicaid programs or other governmental healthcare regulators that Pennsylvania should consider, including approaches that may be transferable to Medicaid.

(d) Provide recommendations for translating analytical findings into actionable policy, oversight, procurement, or rate-setting decisions.

(e) Identify any additional innovative solution, capability, or oversight practice that you believe could provide significant value to Pennsylvania’s Medicaid program but is not otherwise addressed in this RFI.

3.3.3 Data Analytics & Financial Transparency

(a) Describe best practices, emerging practices, or other considerations the Commonwealth should be aware of when analyzing organizational structures, ownership, affiliations, subcontracting arrangements, and financial relationships across Medicaid managed care delivery systems.

(b) Describe methodologies, best practices, or emerging approaches for analyzing financial, funding, and reimbursement flows, including flows between and among affiliated entities and payments or financial arrangements that may not be directly tied to specific service utilization.

(c) Describe best practices, emerging capabilities, or other considerations for identifying utilization trends, expenditure patterns, organizational relationships, or other actionable insights that may support Medicaid oversight and rate setting.

(d) Describe available or emerging reporting, visualization, or decision-support approaches that can assist state agencies in translating analytical findings into actionable oversight, policy, or rate-setting decisions.

(e) Describe guiding principles or best practices regarding transparency for different audiences, including entities for whom rates are established, entities paid from established rates, policymakers, and the public.

(f) Identify data access, data-sharing arrangements, data governance practices, technical capabilities, or other resources that the Commonwealth should consider in order to support these types of analytical and evaluation activities.

3.3.4 Medical Economics & Priority Service Categories

(a) Describe analytical methodologies, best practices, or emerging approaches that state Medicaid agencies should consider to inform rate setting and medical economics, including the identification and evaluation of factors influencing expenditure and utilization trends.

(b) Identify analytical approaches, emerging practices, or other considerations applicable to ABA, Pharmacy Services, LTC, HCBS, and other Medicaid service categories or payment areas that may benefit from enhanced analytics or oversight.

(c) Describe methodologies or best practices for distinguishing among changes in utilization, reimbursement, acquisition costs, acuity, provider mix, value-based or incentive arrangements, and other factors that may influence Medicaid expenditures.

(d) Describe the types of actionable insights that may be derived from these analyses to support financial transparency, program oversight, and future rate-setting decisions.