30-2026-002-DHB_PACSS RFP_Addendum 1_Response to Questions_Issued 20260723.pdf

Solicitation Number: RFP 30-2026-002-DHB Page 1 of 12 Addendum Number: 1

Solicitation Addendum

Solicitation Number: 30-2026-002-DHB

Solicitation Description: Pharmacy Analytical and Clinical Support Services (PACSS) RFP

Deadline to Submit Proposals:

Solicitation Opening Date and Time:

August 6, 2026, by 2:00 p.m. EST August 6, 2026, at 2:00 p.m. EST

Addendum Number: 1

Addendum Date: July 23, 2026

Addendum Description/Purpose: Department Responses to Offerors Questions

Contract Specialist: Kimberly Lozada Medicaid.Procurement@dhhs.nc.gov

NOTIFICATIONS AND INSTRUCTIONS:

1. The following are questions received for this solicitation and the Department’s response to those questions.

2. Return one properly executed copy of this Addendum #1 with your response. Failure to sign and return Addendum #1 may result in the rejection of the Offeror’s proposal.

Addendum Execution on Page 12 mailto:Medicaid.Procurement@dhhs.nc.gov

Solicitation Number: RFP 30-2026-002-DHB Page 2 of 12

No. RFP Section

RFP

Page # Offeror Question Department’s Response

1. General N/A Will the State consider limiting liability on this contract? No.

2. Execution Page 3 Will the State accept a 90-day offer validity period in place of the 240 calendar days on the Execution Page?

No.

3. II.B.8. 8 The RFP asks that Offerors disclose whether Artificial Intelligence (AI), including generative AI tools, was used in the preparation of any portion of its proposal response. It also requires Offerors to affirm that they have reviewed and verified the accuracy, completeness, and appropriateness of all AI-generated content if used. Can the State clarify where in its proposal response Offerors should make this disclosure and affirmation?

Offeror must complete RFP Section VII. Attachment O:

GenAI Disclosure and Fact Sheet.

4. Section III.

Definitions, Contract Term, General Terms and Conditions, Other Provisions & Protections;

Acronyms and Abbreviations

25 The state had defined PUPM as “Per Unit Per Month”. In the past we have known this to mean “Per Utilizer Per Month”.

Can the state clarify which definition is most correct for the scope? If “Per Unit”, could the state please define what a “unit” represents.

Per RFP Section III.B. Acronyms and Abbreviations, PUPM is defined as "Per Unit Per Month" where the term "Unit" represents a financial and utilization metric used to track pharmacy claims and costs.

5. III.D. 26-44 Will the State consider a mutual limitation of liability and an aggregate damages cap?

No.

6. III.D.21. 33 Since the Vendor's proposal sits lowest in the order of precedence, how will the State preserve accepted proposal commitments against conflicting base terms?

See RFP Section III.D.21. Entire Agreement and Order of Precedence.

7. III.D.24. 34 Will the State consider scoping the indemnification to claims arising from the Vendor's negligence or willful misconduct?

No.

8. III.D.27. 35 Will the State confirm whether Cyber Liability or Technology Errors and Omissions coverage is expected, since the clause lists only general, auto, and workers' compensation limits?

Per Section III.D.27. the Contractor, at its sole cost and expense, shall provide commercial insurance coverage of such type and with such terms and limits as may be reasonably associated with the Contract.

9. III.D.33. 37 How does the State intend the perpetual, royalty-free license on derivative works to interact with a Vendor's ownership of pre-existing intellectual property and accelerators?

See RFP Section III.D. 33. Ownership of Deliverables for information regarding the identification of Contractor’s proprietary materials.

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Page # Offeror Question Department’s Response

10. III.D.33. 37 Will the State confirm that Vendor proprietary tools, frameworks, and AI assets remain Vendor property when identified in writing before use?

Yes. See response to question #9 above.

11. IV.D. 52 Will the State confirm whether prime and subcontractor experience can be combined to meet the five-year, three-entity minimum?

No. The Offeror and Offeror's subcontractor experience cannot be combined to meet the five-year, three entity minimum. Offeror alone must have a minimum of five (5) years of experience providing pharmacy analytical and clinical services with a minimum of three (3) entities as detailed in Section IV.D of the RFP.

12. V. 53 Is there a current contractor performing these services today, or is this scope presently delivered within the PBM or PBA contract?

Yes, a vendor is currently performing the services contemplated in the RFP.

13. V.B.3. / V.D. 53 How does the State expect PACSS managed care and encounter monitoring to interact with data and reporting already produced through the State's EDW, to avoid duplicate builds and duplicate cost?

There is not enough information provided for the Department to answer this question.

14. V.D. / V.B.2.k 53-54 Will the State clarify how PACSS rebate audit and MDRP scope relates to any rebate functions already performed by other NC Medicaid vendors, to prevent overlapping scope and pricing?

The Department utilizes the rebate audit and MDRP as a tool to audit the rebate vendor.

15. V.D. 54-66 Is there a specific format for the reporting required, and documentation needed for review listed in V.D.1? If not, what is the DHB review and approval process for contractor-developed reports?

Per RFP Section V.I. Reports, Contractor shall submit reports in accordance with the requirements and timeframes in an agreed upon format, which may include MS Excel, MS Word or other formats based on the report data and requirements.

16. Section V.D.1.c. Page

Can the Department clarify whether bidders are expected to maintain the current SMAC methodology as described in the solicitation, or whether the Department would consider alternative methodologies and pricing approaches that support the same program goals and cost savings?

The Contractor will maintain the current SMAC methodology as described in Section V.D.1. of the RFP.

17. V.D.8. 60 Is there a definition of the "Standard key statistics report utilizing encounter data"? Are they same as the metrics listed in V.D.9.b "Key Pharmacy Statistics"?

Yes. Standard key statistics are the same as the metrics listed in Section V.D.9.b of the RFP.

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Page # Offeror Question Department’s Response

18. V.D.8 60 Will the vendor be responsible for communicating with the managed care plans?

No.

19. V.D.8 60 Will the vendor be responsible for training the managed care plans if monitoring reports identify gaps or risks?

No.

20. V.D.10 62 Who needs to have access to the Web Portal? The Department's Office of Pharmacy staff.

21. V.D.10 62 Is the Web Portal used for delivery of the monthly, quarterly, annual, and ad-hoc reports?

No.

22. V.E. 66 Will DHB provide direct access to claims, encounters, rebate, and pharmacy data sources?

Yes, with the exception of rebate data.

23. V.D.7, V.D.8, V.E. 66 Will any DHB analytic environments or DHB tools will be available to the Contractor?

No.

24. V.E. 66 Is there any rescritction on using ai-assisted analytics? See RFP #30-2026-002-DHB Addendum #2 for revisions to the RFP.

25. V.E.1 66 What are considered the designated systems determined by the Department for tracking and documentation?

The Department is unable to provide this information at this time.

26. V.E.4 66 The Vendor must maintain DRG Grouper and MCE software identical to the Department's. Will the State specify the exact product and version so pricing reflects a match rather than a new license?

The Department currently uses MS-DRG Grouper software, Version 43.1 and is updated annually.

Contractor must monitor CMS for the release of updated versions during the year and implement updated versions when they are released by CMS. The MCE Software Update Process (R-P-470) performs the annual update of the MCE. The changes are effective on/after October 1. The State orders the software from the U.S. Department of Commerce National Technical Information Service (NTIS). This process runs when the software is received from the State.

27. Section V.E.

Technology Specifications, #4

66 Section V.E. Technology Specifications (#4) and Evaluation Question 2.b require the Contractor to "maintain its own DRG Grouper software along with the appropriate version of the Medicare Coding Edits (MCE) identical to the software used by the Department, which shall also match with the NC Medicaid State Plan." While Definition #19 notes the Department uses the DRG assignment logic of the Medicare Grouper, could the Department please clarify:

1. Per RFP Section V.E. Technology Specifications, 4.

the Contractor shall maintain its own DRG Grouper software along with the appropriate version of the Medicare Coding Edits (MCE) identical to the software used by the Department which shall also match with the NC Medicaid State Plan.

a. The Department purchases the software and will provide the Contractor access to

Solicitation Number: RFP 30-2026-002-DHB Page 5 of 12

Page # Offeror Question Department’s Response

1. Please clarify whether the Contractor is required to obtain and maintain separate licenses for the DRG Grouper and MCE software, or whether access to Department-supported grouper tools or outputs will be provided. Additionally, please indicate whether equivalent software producing identical DRG assignment results would satisfy this requirement. If not, please identify the specific software products and versions currently utilized by the Department;

2. Which task(s) and deliverables within the Scope of Work the DRG Grouper software supports, and how the output is used in service delivery?

Department-supported grouper tools or outputs.

b. The Department purchases the software and will provide the Contractor access to Department-supported grouper tools or outputs.

c. MS-DRG Grouper software currently being used by the department is version 43.1 and is updated annually. Contractors must monitor CMS for the release of updated versions during the year and implement updated versions when they are released by CMS. The MCE Software Update Process (R- P-470) performs the annual update of the MCE. The changes are effective on/after October 1. The State orders the software from the U.S. Department of Commerce National Technical Information Service (NTIS). This process runs when the software is received from the State.

2. Per RFP Section II.A. Definitions, 19. Diagnosis- Related Group (DRG) Grouper Software is a computer software program used for billing medical and hospital services that arranges diseases by diagnostic categories and groups them according to the resources needed for care.

The Department uses the DRG assignment logic of the Medicare Grouper to assign individual claims to a DRG category and installs the most recent version implemented by Medicare to be effective October 1 of each following rate year.

28. V.F. 67 What's the annual volume of custom support calls recieved accross the last 2 years?

The Department is unable to provide this information at this time.

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Page # Offeror Question Department’s Response

29. V.F.2. 67 What do you consider Qualified Staff to answer the toll-free customer service number?

Contractor staff operating in the customer support role must be able to meet the requirements detailed in RFP Section V.F. Customer Support and Section V.G.

Staffing.

30. V.F. 67 Are we able to use AI tools as part of the customer service work?

See RFP #30-2026-002-DHB Addendum #2 for revisions to the RFP.

31. V.F. 67 Are service level agreements expected for response and resolution times?

Yes. See Service Level Agreements and Performance Standards, detailed in Section VI.F. Table 1 of the RFP.

32. V.F. 67 Does DHB require a ticketing system? No

33. V.F. 67 Will DHB provide a ticketing platform or should the Contractor provide one?

No. A ticketing platform is not required.

34. V.G. 67 Is on-site presence required? If so, how often and for which roles?

See Section V.C. of the RFP. Where a requirement specifies a location for completion of a task or function, the Contractor is required to be at that location. The Department is unable to provide the frequency and roles.

35. V.G. Table 1 69 Can you confirm that the minimum requirements for the analytic expert is a certified pharamcy technician?

Confirmed.

36. V.G. 69 Can DHB provide current staffing structure and estimated staffing levels supporting the existing contract?

The Department is unable to provide this information as part of the Question and Response process for this

RFP.

37. V.I.1. 70 Is there a specific format for the reporting required, and documentation needed for review listed in V.I.1 (tables on 70- 72)?

See response to question #15 above

38. V.I.4. 70 What is the historic and expected frequency of ad hoc data requests? What is the typical data volume of number of products in the inquiry or time frame?

a. Ad-hoc requests occur on an as needed basis as directed by the Department and as defined within the ad hoc request.

b. Ad hoc financial and pharmacy reports and services are estimated to be one thousand (1,000) hours annually as described in Section V.D.19 and Section VII. Attachment C: Cost Proposal of the

RFP.

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Page # Offeror Question Department’s Response

39. V.I. Table 1 70-72 What exists today for reporting? Are these reports automatically generated based on data feeds or are they manually generated? Where does the data for these reports reside (i.e., SQL Server, etc.). On how many of the reports will there be a reliance on incoming data? How many data providers and is the format consistent?

a. Existing reports are manually generated based on encounter and claims data that are transferred to the Contractor.

b. Currently some reports utilize an automation process. The data for the reports are housed in the Encounter Processing System (EPS) and encounter data from EPS is transmitted to the vendor to create the reports. All reports will have a reliance on incoming data and the vendor will need to make sure the data coming to them is useable and in a format that allows them to capture the appropriate data values. Coordination is required to make sure the data values map to the appropriate field.

c. Additional claims level detail are researched by the Contractor through logging into the Department's pharmacy systems.

40. V.J. / Attachment C

72, 97 The Cost Proposal allows implementation costs in Year 1 only.

What implementation duration and go-live date does the State expect, and can implementation run shorter than a full year?

Per RFP Section V.J. Implementation, PACSS shall be implemented statewide within ninety (90) Calendar Days of the Contract Effective Date.

41. V.J.5. 73 How many attendees for onboarding and training are expected? Is there an expected training length, standard 'entrance' critieria' or expected 'pass/fail' assessment critieria or is attendance expected?

Is there expectation of remote, in-person and hybrid options?

How many sessions are expected? Are there needs for various learning aids - text, audio, etc.

The Department does not have enough information to answer this question.

Per RFP Section V.H. Training 2., “All training shall be held at times and locations mutually agreed upon between Department and Contractor, which may include virtual options when approved by the Department."

42. V.K.2. 74 Can a sample policy be shared? What is the expected length and level of detail. Will these be net new SOPs or is there an expectation to update existing SOPs

a. No.

b. See Section V.K. Quality Assurance.

c. The Department does not have enough information to answer this question.

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Page # Offeror Question Department’s Response

43. V.K.2. 74 What is the expectation for adverse event reporting (ICSR) to the FDA?

There is not enough information for the Department to answer this question.

44. V.L. 74 Must the continuity plan include contact options for every project team member or are back ups sufficient (ie for vacations)

See Section V.L. of the RFP for guidance regarding contents of the Business Continuity Plan.

45. Section V.L.

Business Continuity Plan, #2

74, 79 There appear to be conflicting submission timelines for the Business Continuity Plan. Evaluation Question 10 in Attachment B states the "Response must include a detailed Business Continuity Plan," indicating submission with the proposal, while Section V.L.2 and the Deliverables table state the Contractor shall submit its initial Business Continuity Plan "no later than forty-five (45) days of the Contract Effective Date." Could the Department please confirm:

1. Whether the detailed Business Continuity Plan is required with the proposal response, or within 45 days of the Contract Effective Date as stated in Section V.L.2;

2. If required with the proposal, whether the Department will accept submission of the Plan's table of contents/outline with the response (with the full detailed Plan, appropriately redacted, provided upon award), given that these plans contain proprietary and confidential vendor information?

3. Section V.L.2 references "45 State Business Days" while the table on page 79 references "45 Calendar Days". Can the state please clarify which timeline applies?

1. A detailed draft Business Continuity Plan is required with Offeror’s response. See RFP #30- 2026-002-DHB Addendum #2 for revisions to the

2. No. Per RFP Section II.E.4.h., Offeror should submit all proposal redactions as part of the electronic copy of Offeror’s redacted proposal to the NC eVP in accordance with Chapter 132 of the General Statutes, Public Records.

3. Offerors shall submit a Business Continuity Plan no later than forty-five (45) State Business Days after the Contract Effective Date and annually thereafter in accordance with Section V.L. of the

See RFP #30-2026-002-DHB Addendum #2 for revisions to the RFP.

46. VI.D.3. 76 Will the State consider deferring collection of assessed liquidated damages until an appeal concludes, rather than imposing them during the pending dispute?

Yes. See RFP 30-2026-002-DHB Section VI.D.2.b.

47. Attachment B Questions 4 and

87 and

Both questions 4 and 6 ask Offerors to describe how they meet the requirements of the RFP in accordance with Section V.C. Qualifications and Program Administration Requirements.

Does the State intend Offerors to address the same RFP requirements in both questions, or would it be acceptable to cross reference to either question 4 or 6?

No. The Evaluation Committee will only consider information provided in response to each specific question within the Offeror's Section VII. Attachment B: Offeror's Response to Technical Evaluation Questions as detailed in Section VII. Attachment N:

Evaluation Methodology.

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Page # Offeror Question Department’s Response

48. Attachment C 97 Will the State clarify whether the firm-fixed pricing requirement permits any adjustment for a State-directed change in scope?

There is not enough information for the Department to answer this question.

49. Attachment C 97 What is the estimated annual budget or not-to-exceed for Program Administration, given the reference to maximum allowable amounts per category?

The Department does not have an estimated annual budget or not-to-exceed for Program Administration.

50. Attachment C Pages 97–101

Please confirm whether the payment and invoice amounts identified by, and payable to, the contractor will be based on the time taken to perform each report/analysis/audit (i.e., per quarter hour at a pre-established bill rate), or whether the invoice and payment amount will be a fixed fee (i.e., the invoiced amount would be the monthly/annual amount identified in the cost proposal for each report/analysis/audit).

Per RFP Section VII: Attachment C: Cost Proposal, costs should be all inclusive, incorporating all requirements and responsibilities as defined in this RFP, including all personnel and non-personnel costs associated with the ongoing activities. Implementation costs for year one should also be all inclusive to include technology and non-information technology costs, as well as deliverables defined in Section III.E.9. Privacy and Security Related Deliverables and Section V.J.

Implementation of the RFP. Offeror must submit a detailed narrative explaining what is included in each submitted cost. No payments will be made for items not quoted in the Offeror's Section VII. Attachment C:

Cost Proposal of the RFP. Payment for monthly program administration costs and year one implementation costs are described in RFP Section III.D.34. Payment and Invoice Terms.

51. Attachment C 97-101 Will the State confirm that no costs outside the worksheets, including travel or pass-through expenses, will be reimbursed, so all such costs must be built into the priced cells?

Confirmed.

52. Attachment C 100-

Can the State provide claim volumes, drug spend, and report frequencies so the monthly deliverable pricing can be estimated, since there is no current contract from which to draw historical volumes?

Offerors can access historical data at:

https://medicaid.ncdhhs.gov/reports/annual-reports-and-tables https://medicaid.ncdhhs.gov/reports/annual-reports-and-tables https://medicaid.ncdhhs.gov/reports/annual-reports-and-tables

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Page # Offeror Question Department’s Response

53. Attachment C 100-

Program Administration is priced as a monthly cost for each of 19 deliverables. Should every listed deliverable carry a monthly price, even those produced quarterly or annually, with the cost spread across twelve months so the annual total reconciles?

Per RFP Section VII: Attachment C: Cost Proposal, program administration cost for PACSS shall be all inclusive, incorporating all requirements and responsibilities as defined in the RFP, including all personnel and non-personnel costs associated with the ongoing activities.

54. Attachment C 101 The Ad-hoc Reports tab uses an estimated 1,000 hours at an hourly rate. Is the 1,000-hour estimate fixed for evaluation only, and will actual payment follow hours used at the proposed rate?

As described in Section V.D.19 and Section VII.

Attachment C: Cost Proposal of the RFP, ad-hoc requests occur on an as needed basis as directed by the Department and as defined within the Ad hoc request. Ad hoc financial and pharmacy reports and services are estimated to be one thousand (1,000) hours annually. The Contractor shall separately invoice the Department for each ad hoc report. The cost shall not exceed the cost projected in the Offeror's proposal.

55. Attachment C 101 The "Weekly Data Transfer and Database Maintenance" line:

can the State describe the source systems, file specifications, and frequency expected, and whether this can be satisfied through existing NC Medicaid EDW interfaces rather than a new database build?

The Department does not have enough information to answer this question.

56. Attachment J 117 Will the State commit to negotiating proposed modifications through a BAFO or negotiation document, given proposed redlines have no effect until the State incorporates them?

As detailed in RFP Section VII: Attachment J: Offeror Request for Proposed Modifications to the Terms and Conditions, the Department at its sole discretion may consider any proposed modifications submitted by an Offeror. Department approved modifications will be incorporated as part of the awarded contract via BAFO, negotiation document, addenda to the RFP or amendment to the awarded contract.

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Page # Offeror Question Department’s Response

57. Attachment K and Attachment L

118-

What specific terms must flow down to subcontractors, and will the State accept the prime's standard back-to-back BAA language?

a. Contractor must ensure its subcontractors adhere to the requirements in the RFP including, but not limited to, RFP Section III.D. General Terms and Conditions, 43. Subcontractors.

b. Offeror is required to adhere to the requirements in RFP Section VII. Attachment K: Business Associate Agreement.

58. Attachment N 124 What is the relative weight of cost versus technical factors in the best-value trade-off, since the methodology does not state percentages?

Per RFP Section VII. Attachment N, Offeror proposals will be evaluated in accordance with NCGS 143-135.9 to determine which response provides the best trade-off between price and performance. Offeror proposals will be ranked from most advantageous to least advantageous using the evaluation factors stated in this RFP and their relative importance, and comparatively across all Offerors.

59. Attachment N 124 “Attachment N: Evaluation Methodology” is not included as an attachment in the Ariba procurement portal along with the other RFP attachments. Is there anything vendors should anticipate responding to in this document?

No. Section VII. Attachment N: Evaluation Methodology does not require a response from the Offeror.

60. Attachment O 127-

Attachment O seems to refer to an IT solution. Can the State please clarify whether Attachment O is required for this solicitation?

Yes. Offeror must complete RFP Section VII.

Attachment O: GenAI Disclosure Fact Sheet as indicated.

Solicitation Number: RFP 30-2026-002-DHB Page 12 of 12

Execute Addendum #1:

Offeror:

Authorized Signature:

Name and Title (Typed):

Date: