30-2026-002-DHB_PACSS RFP_Addendum 2_RFP Revisions_Issued 20260723.pdf

Solicitation Number: RFP 30-2026-002-DHB Addendum Number: 2

Solicitation Addendum

Solicitation Number: 30-2026-002-DHB

Solicitation Description: Pharmacy Analytical and Clinical Support Services

Deadline to Submit Proposals:

Solicitation Opening Date and Time:

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

Addendum Number: 2

Addendum Date: July 23, 2026

Addendum Description/Purpose: Revisions to the RFP

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

NOTIFICATIONS AND INSTRUCTIONS:

1. Carefully read, review, and adhere to all revisions to the RFP in this Addendum #2.

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

Addendum Execution on Page 19 mailto:Medicaid.Procurment@dhhs.nc.gov

1. The following revisions are made to the RFP.

a. Section III.DEFINITIONS, CONTRACT TERM, GENERAL TERMS AND CONDITIONS, OTHER PROVISIONS & PROTECTIONS, E. CONFIDENTIALITY, PRIVACY AND SECURITY PROTECTIONS, is amended to add the following provision:

10. Use of Artificial Intelligence

a. The transparent, secure, responsible, and ethical deployment of Artificial Intelligence (“AI”) is essential to ensuring accountability and the protection of civil liberties in government operations and decision-making. The Recipient/Contractor is fully and solely responsible and liable for and must disclose, upon request, the use of AI technologies within the proposed product, service, and performance. These AI technologies include, but are not limited to Machine Learning, Natural Language Processing (“NLP”), Generative AI (“GenAI”), Predictive Analytics (“Predictive AI”), Assistive AI, Conversational AI, and Computer Vision.

b. Any use of AI in the performance of the contact shall be implemented in compliance with the North Carolina State Government Responsible Use of Artificial Intelligence Framework.

c. If AI is being used, the Contractor shall provide, upon request, a detailed summary to the Department’s Contract Administrator for day-to-day activities, which specifically identifies how security and privacy are addressed within the AI portions of the application. Minimally this detailed summary shall include the following:

i. The purpose and scope of AI’s use;

ii. How the AI will be implemented in a manner that is compliant with the seven (7) principles and practices identified in Framework for Responsible Use of Artificial Intelligence;

iii. How the Contractor will ensure data classified as Medium Risk (“Restricted”) or High Risk (“Highly Restricted”) under the NC Statewide Data Classification and Handling Policy is not used to train AI models unless explicitly authorized by the NC DHHS Business Owner and the PSO;

iv. Safeguards used to prevent unauthorized access, use, or disclosure of data used by the AI; and

v. Inclusion of a statement setting forth how Contractor’s use of AI in the performance of Contractor’s services is consistent with the NIST AI Risk Management framework.

d. The Department reserves the right to authenticate and verify Contractor’s adherence to the provisions of this Section and Contractor shall make good-faith, reasonable efforts to cooperate with the Department to do so.

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b. Section VI. CONTRACT PERFORMANCE, F. PERFORMANCE STANDARDS AND LIQUIDATED DAMAGES, Table 1, is revised and restated in its entirety and renamed First Revised and Restated Section VI.F.

Table 1: Performance Standards and Liquidated Damages as follows:

First Revised and Restated Section VI.F. Table 1: Performance Standards and Liquidated Damages Item

Measure Performance

Standard Measurement

Period Description Liquidated

Damage

1. Contract

Provisions and Requirements

Contractor shall comply with one hundred percent (100%) of the provisions and requirements in the Contract.

Monthly Contractor is required to comply with all of the provisions and requirements of the Contract in the RFP and Section III.D.

General Terms and Conditions.

Five hundred dollars ($500) per occurrence per Calendar Day.

2. Deliverables and Reporting Metrics

Contractor shall submit one hundred percent (100%) of the reports and deliverables required by the due dates in the Contract and Section V.I. Table 1:

Reporting Metrics.

Monthly Submission of complete and accurate reports and deliverables in the format and on the due dates in Section V.I. Table 1:

Reporting Metrics, or as approved by the Department.

Two hundred fifty dollars ($250) per occurrence

3. Business Continuity Plan

a. Contractor shall provide the Department with an initial Business Continuity Plan no later than forty-five (45) State Business Days of the Contract Effective Date.

b. Contractor shall provide a Business Continuity Plan annually thereafter, no later than thirty

(30) Calendar Days after Department’s request.

Annually Contractor is required to submit and implement an initial Business Continuity Plan required in Section V.L. Business Continuity Plan and submit subsequent reports annually or as directed by the Department and in Section V.L. Business Continuity Plan of the Contract.

Two hundred fifty dollars ($250) per Calendar

First Revised and Restated Section VI.F. Table 1: Performance Standards and Liquidated Damages Item

Measure Performance

Standard Measurement

Period Description Liquidated

Damage

4. Confidentiality, Privacy and Security Protections

Contractor must comply with one hundred percent (100%) of the Department’s confidentiality, privacy and security protection provisions in the Contract.

Monthly Contractor must timely and accurately comply with confidentiality, privacy and security protection provisions in Section III. E.

Confidentiality, Privacy and Security Protections of the Contract.

Five hundred dollars ($500) per occurrence

c. Section VII. Attachments to the RFP, Attachment B: Offeror’s Response to Technical Evaluation Questions is revised and restated in its entirety to make a correction to Question #10 and renamed First Revised and Restated Attachment B: Offeror’s Response to Technical Evaluation Questions and attached to this Addendum #2. Offeror’s must download and use the MS Word Version of First Revised and Restated Attachment B: Offeror’s Response to Technical Evaluation Questions posted on the North Carolina electronic Vendor Portal (NC eVP) for proposal submission.

The remainder of this page is intentionally left blank.

First Revised and Restated Attachment B: Offeror’s Response to Technical Evaluation Questions

Instructions:

Offeror must respond to all questions and each part and subpart to each question in Section VII. First Revised and Restated Attachment B: Offeror’s Response to Technical Evaluation Questions. Offeror’s response to each question must follow the corresponding question. The Offeror must confirm adherence to and describe its approach to meet the requirements of the Contract as indicated. This includes providing a detailed narrative, diagrams, exhibits, examples, sketches, descriptive literature and/or detailed information specifically tailored for the North Carolina Medicaid program to demonstrate Offeror’s ability to meet specifications of the PACSS RFP. The Offeror’s Response to Technical Evaluation Questions should clearly indicate the citation and/or location of exhibits, attachments, flows, etc. that supplement responses in this Attachment B and demonstrate understanding and the ability to meet each specification. The Department is not required to look for or consider information outside of the response for individual questions where the Offeror fails to clearly indicate the location of supplemental exhibits, attachments, flows, etc. Further, where indicated and applicable, Offeror must describe any limitations or issues it has with meeting the requirements of the question. Offeror’s response to each question must follow the corresponding question. The Department reserves the right to validate information provided within Offeror’s response.

The table below provides an overview of the evaluation criteria and the questions within this Attachment B that correspond to each criterion. Cost will be evaluated based on the response to Section VII. Attachment C: Cost Proposal. The table below is provided for convenience only, and each question may encompass requirements from multiple sections of the RFP. The evaluation processes, including those for costs, are explained further in Section VII. Attachment N: Evaluation Methodology.

Summary of Evaluation Criteria and Corresponding Questions Question #s Evaluation and RFP Scope Section RFP Section Reference

1. – 5. Service Delivery Criteria

1. Pharmacy Analytical and Clinical

Support Section V.B. General Requirements and Section V.D.

Pharmacy Analytical and Clinical Support Services Requirements

2. Technology Specifications Section V.E. Technology Specifications

3. Customer Support Section V.F. Customer Support

4. Staffing Section V.G. Staffing and Section V.C. Qualifications and Program Administration Requirements

5. Training Section V.H. Training

6. – 11. Program Administration Criteria

6. Program Administration Section V.C. Qualifications and Program Administration

Requirements

7. Performance Reporting and

Delivery Requirements Section V.I. Reports and Section VI. Contract Performance

8. Implementation Section V.J. Implementation

9. Quality Assurance Section V.K. Quality Assurance

10. Business Continuity Section V.L. Business Continuity Plan

11. Privacy and Security Protections Section III.E.9. Privacy and Security Related Deliverables

12. – 13. Qualifications and Experience Criteria

12. – 13. Past Experience and Performance

Technical Evaluation Questions

A. SERVICE DELIVERY

Pharmacy Analytical and Clinical Support

Evaluation Question

1. Offeror must confirm adherence to the requirements of the Department, and describe its ability, capacity and proposed approach to meet the requirements of the RFP and Section V.B. General Requirements and Section V.D. Pharmacy Analytical and Clinical Support Services Requirements.

The response should address the Offeror’s proposed approach to providing a cost saving solution that supports the core functions of the Department’s Pharmacy Program. The solution shall have the capability to monitor and analyze Pharmacy Program data and the ability to develop fee schedules, publications, and reports based on data evaluated to include the following:

a. State Maximum Allowable Cost Medications (SMAC) rate listing;

b. Specialty drug list;

c. Preferred Drug List (PDL) with supplemental rebates and Prior Authorization (PA) Program;

d. Beneficiary Management Lock-in Program (Lock-in Program);

e. Physician Administered Drug Program (PADP);

f. Vaccine Point of Sale (POS) fee schedule;

g. Medicaid Drug Rebate Program (MDRP);

h. Managed care plans and Fee-for-Services (FFS) Program monitoring;

i. Pharmacy initiatives, savings, tracking, and other key statistics;

j. Utilization and clinical reviews of new drugs;

k. Rebate audit;

l. Report card;

m. Durable Medical Equipment (DME) oversight;

n. Medical PA oversight;

o. Over the Counter (OTC) policy adherence;

p. Federal Upper Limit (FUL) aggregate analysis;

q. Dispensing Fee aggregate analysis;

r. Cost of Dispensing (COD) survey; and

s. Ad hoc reporting.

☐ Offeror confirms adherence ☐ Offeror does not confirm adherence

Offeror’s Response:

Click or tap here to enter text.

The Offeror must describe any limitations or issues meeting the requirements of this question.

☐ Offeror has no limitation(s) or issues(s).

☐ Offeror has limitation(s) or issue(s) described following their response below.

Technology Specifications

Evaluation Question

2. Offeror must confirm adherence to the requirements of the Department, and describe its ability, capacity and proposed approach to meet the requirements of the RFP and Section V.E. Technology Specifications.

The response should describe in detail Offeror’s approach and experience for each of the following:

a. Maintaining a secure, web-enabled system to provide a client resource portal for the secure request and collection of clinical summaries, call records, file transfers, and resources, including all elements listed in Section V.E. Technology Specifications; and

b. Maintaining 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 State Plan.

Customer Support

Evaluation Question

3. Offeror must confirm adherence to the requirements of the Department, and describe its ability, capacity and proposed approach to meet the requirements of the RFP and Section V.F. Customer Support.

The response should address:

a. Operation of a toll-free customer service telephone number and fax line to assist providers with rate inquiries and questions related to the maintenance of the SMAC program;

b. Response to medical, pharmacy, and claims adjudication inquiries including but not limited to:

i. SMAC rate and calculation process;

ii. Maintenance of the clotting factor SMAC program;

iii. Changes in the acquisition cost of a drug;

iv. Changes in product availability; and

v. Obtaining a copy of the SMAC listing.

Staffing

Evaluation Question

4. Offeror must confirm adherence to the requirements of the Department, and describe its ability, capacity and proposed approach, including the use of any Subcontractors, to meet the requirements of the RFP in accordance with Section V.C. Qualifications and Program Administration Requirements and Section V.G.

Staffing.

The response must:

a. Include proposed Key Personnel, including the individuals’ credentials and experience specific to the identified role. If Offeror has not identified Key Personnel at the time of submitting its proposal, Offeror must state the actions it will take to ensure Key Personnel are identified and in place in accordance with all timelines;

b. Include a detailed draft Staffing Plan with an organizational chart with Key Personnel, and the number of staff/roles for performance of services under each work area; and

c. Approach for performing services statewide, including use of teleworking or hybrid models, and required in-person activities.

Response

Training

Evaluation Question

5. Offeror must confirm adherence to the requirements of the Department, and describe its ability, capacity and proposed approach, to meet the requirements of the RFP in accordance with Section V.H. Training.

The response must include a detailed Training Plan that addresses each of the following:

a. Approach to ensuring all personnel, including Subcontractors, Providers and other stakeholders meet all training requirements and timelines.; and

b. Processes to develop and update its ongoing training curriculum, to include:

i. Topic areas;

ii. Desktop procedures; and

iii. Delivery methods.

c. Attendance of the Department’s Fiscal Agent’s and PBA training sessions.

Response

B. PROGRAM ADMINISTRATION

Program Administration

Evaluation Question

6. Offeror must confirm adherence to the requirements of the Department and describe its capacity, processes, procedures, systems and infrastructure necessary to meet the requirements of the RFP and Section V. C.

Qualifications and Program Administration.

The response must include each of the following:

a. Processes, procedures and approach to incorporating all Department required tools, templates and systems for the performance of services;

b. Approach to providing technical assistance to its personnel to successfully use all Department required tools, templates and systems for the performance of services;

c. Process for tracking adherence to protocols and guidance for face-to-face meetings; and

d. Process for complying with Medicaid Beneficiary Due Process Rights:

Performance Reporting and Delivery Requirements

7. Offeror must confirm adherence to the requirements of the Department and describe its capacity and approach to meet the requirements of the RFP in accordance with Section V.I. Reports and Section VI. Contract Performance.

Response must detail Offeror’s approach for adherence to reporting metrics and processes to ensure accuracy, completeness, and timely submission of all reports, data and service delivery.

Implementation

Evaluation Question

8. Offeror must confirm adherence to the milestones, activities, and schedule in Section V.J. Implementation.

Response must include a detailed draft Implementation Plan that incorporates, at a minimum, all elements listed in Section V.J. Implementation and demonstrates the Offeror’s capacity to meet the timeline and requirements of the RFP. Offeror should describe its approach for Kickoff and Onboarding meetings and suggested topics to be included.

Quality Assurance

Evaluation Question

9. Offeror must confirm adherence to the requirements of the Department and describe its capacity and approach to meet the requirements of the RFP and Section V.K. Quality Assurance.

The response must include:

a. A description of Offeror’s quality assurance policies, procedures and practices it will implement to ensure completion and validation of the accuracy of the services required in the RFP;

b. A detailed draft Quality Assurance Plan (QA Plan) that includes, at a minimum, all elements of Section V.K.

Quality Assurance; and

c. Approach for participation in Department initiated reviews and incorporation of feedback and recommendations.

Business Continuity and Disaster Recovery

Evaluation Question

10. Offeror must confirm adherence to the requirements of the Department and describe its ability and approach to meet the requirements of the RFP and Section V.L. Business Continuity Plan.

Response must include a detailed draft Business Continuity Plan that meets all requirements and elements of Section V.L. Business Continuity Plan.

Privacy and Security Protections

Evaluation Question

11. Offeror must confirm adherence to and describe its ability and approach to meet all Confidentiality, Privacy and Security Protections defined within the RFP. The response must include the following from Section III.E.9.a:

a. Vendor Readiness Assessment Report (VRAR) https://it.nc.gov/documents/vendor-readiness-assessment-report;

b. System Security Plan (SSP) example template should be requested from

Medicaid.Procurement@dhhs.nc.gov;

c. Vendor SOC 2 or ISO 27001 or FedRamp or equivalent compliance certificates;

d. Network Architecture Diagram https://it.nc.gov/resources/statewide-it-procurement/vendor-engagement-resources; and

e. Data Flow Diagram and Description.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi6qoub64aKAxWhFlkFHZX0GDIQFnoECB4QAQ&url=https%3A%2F%2Fit.nc.gov%2Fdocuments%2Ffiles%2Fvendor-readiness-assessment-report-non-state-hosted-solutions%2Fopen&usg=AOvVaw3i-RDg91tOp-lFXfsQmcVt&opi=89978449 https://it.nc.gov/documents/vendor-readiness-assessment-report https://it.nc.gov/documents/vendor-readiness-assessment-report mailto:Medicaid.Procurement@dhhs.nc.gov https://it.nc.gov/resources/statewide-it-procurement/vendor-engagement-resources https://it.nc.gov/resources/statewide-it-procurement/vendor-engagement-resources

C. QUALIFICATIONS AND EXPERIENCE

Past Experience and Performance

12. Offeror must describe their past experience providing services similar to those included in the requirements of Section IV. Minimum Qualifications. D. Experience Requirements and Section VII. Attachment A: Minimum Qualifications, 4. Experience Requirements.

Response must:

a. Identify other State Medicaid or other programs for which Offeror has performed substantially similar services and include the number of years providing the services;

b. Describe the factors, experience, and processes that make Offeror qualified to successfully provide the statewide services required by this RFP;

c. Detail Offeror’s experience and capability collaborating with the provider community, beneficiaries, and other stakeholders; and

d. Explain how success was measured and validated.

Evaluation Question

13. Offeror must provide a list of contracts for services that are similar to those described in this RFP in the last seven (7) calendar years and disclose information required in Section VII. Attachment H: Disclosure of Litigation and Criminal Convictions.

Offeror’s response should:

a. Disclose any performance or compliance issues, termination, non-renewal, withdrawal, or services reduction; that occurred in any Contract held by the Offeror in the past seven (7) calendar years;

b. For any Contract that was terminated due to contractual breach or insufficient performance within the past seven (7) calendar years, Offeror response must explain the circumstances or reasons surrounding the termination, non-renewal, withdrawal, or services reduction; the parties involved; and provide the name, address and telephone number of the client/other party;

c. If the Contract was terminated/non-renewed based on the Offeror’s performance, The Offeror shall describe any corrective actions taken to prevent any future occurrence of the problem leading to the termination/non-renewal;

d. If the violation(s) was the subject of an administrative proceeding or litigation, the Offeror shall indicate the result of the proceeding/litigation; and

e. If Offeror has no such terminations, Offeror must respond by stating no terminations have occurred.

Offeror has disclosed all information required in Section VII. Attachment H: Disclosure of Litigation and Criminal Convictions.

☐ Yes

☐ No. (If this box is checked, Offeror must indicate the reason below as part of Offeror’s Response.)

Execute Addendum #2:

Offeror:

Authorized Signature:

Name and Title (Typed):

Date: