40DHHS-S3339 - Cost Schedules MCO-DBA Specialty MCO NEMT~1.xlsx
XLSX spreadsheet 29 KB Posted
- Attached to
- Actuarial Services State and local contract opportunity
- Solicitation number
- 40DHHS-S3339
- Issued by
- Clark County, Nevada
About this file
This is a cost schedule Excel file for the Nevada Department of Health and Human Services (DHHS), specifically for Managed Care Organizations (MCOs), Dental Benefits Administrator (DBA), Specialty MCO, and Non-Emergency Medical Transportation (NEMT) Actuarial Services. The document outlines a 5-year contract term focused on actuarial services, including capitation rate development, rate modifications, risk adjustments, and various reporting requirements. The contract covers services for Nevada Medicaid and Nevada Check Up (CHIP) populations, with work to be performed collaboratively with the current vendor to finalize calendar year 2026 rate building.
The cost schedule includes provisions for a resource pool of contracted actuarial and financial vendors, with detailed hourly rate structures for different professional levels including Principals (FSA), Reviewing/Managing Actuaries, Consulting Actuaries, Actuarial Analysts, and Non-Actuarial Support staff. While the specific monetary values are not filled in (showing as $-0), the document provides a comprehensive framework for pricing ad hoc services and ongoing actuarial support. The contract emphasizes conformity with the most recently published Medicaid Managed Care Rate Development Guide (2024-2025) and requires vendors to provide cost estimates, methodology, calculations, and follow-up services across multiple service categories.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 40DHHS-S3339 - BAA Global DHHS August 2024.docx | DOCX document | |
| Standard-form-contract~9.docx | DOCX document | |
| 40DHHS-S3339 - DHCFP Business Continuity Agreement_v2.docx | DOCX document | |
| 40DHHS-S3339 - Scopes of Work.docx | DOCX document | |
| Certification-regarding-lobbying~9.pdf | ||
| Vendor Information Response.pdf | ||
| Questions - Answers~2.xlsx | XLSX spreadsheet | |
| 40DHHS-S3339 -Reference-Questionnaire-2025-05-07~1.pdf | ||
| 40DHHS-S3339-RFP Actuarial Services.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 40DHHS-S3339 - Caseload Projections with Retros.xlsx | XLSX spreadsheet | |
| 40DHHS-S3339 - Insurance Schedule - RFP.pdf | ||
| Terms-and-conditions-for-services~9.pdf |
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Text version
Medical MCO & DBA 40DHHS-S3339 - MANAGED CARE ORGANIZATIONS (MCOs) AND DENTAL BENEFITS ADMINISTRATOR (DBA) ACTUARIAL SERVICES
Instructions: Vendor must provide a cost estimate in Column F for the services listed below. Please provide costs for ad hoc services within the Proposed Resource Pool tab.
| Should travel be needed under the scope of services, the cost of travel shall be inclusive in the overall deliverable costs. If travel costs exceed the overall deliverable cost, Contractor shall be responsible for the difference. | ||||||||
| Task Area - Reference Scope of Work for details pertaining to each item. | Cost per Deliverable | Years of Contract Term | Total Cost | |||||
| Capitation Rate Setting* | ||||||||
| A. | Capitation Rate Development for Nevada Medicaid and Nevada Check Up (CHIP) populations: | |||||||
| Methodology, Calculations, Preliminary Rate Estimates, and Follow up for Medical and Dental Benefuts Adminidtrator MCOs | $ - 0 | 5 | $ - 0 | |||||
| B. | Capitation Rate Modifications and Adjustments: | |||||||
| Interim Prospective Risk Adjustments, Risk Adjustments, Risk Sharing Mechanisms, Risk Mitigation, Analysis | $ - 0 | 5 | $ - 0 | |||||
| Other Rate Setting Services | ||||||||
| C. | Encounter Data and Encounter Utilization Monitoring | |||||||
| Medical MCOs - Nevada Medicaid and Check-up populations | $ - 0 | 5 | $ - 0 | |||||
| Dental Benefits Administrator MCO | $ - 0 | 5 | $ - 0 | |||||
| D. | Experience Monitoring and Reporting: |
Risk Adjustment, Risk Mitigation
| Medical MCOs - Nevada Medicaid and Check-up populations | $ - 0 | 5 | $ - 0 | ||
| Actuarial Projects | |||||
| E. | Medical Loss Ratio (MLR) Report Review | ||||
| Medical MCOs - Nevada Medicaid and Check-up populations | $ - 0 | 5 | $ - 0 | ||
| Dental Benefits Administrator MCO | $ - 0 | 5 | $ - 0 | ||
| F. | Family Planning Services Enhanced Federal Medicaid Assistance Percentage (FMAP) Claiming Identification | ||||
| Medical MCOs - Nevada Medicaid and Check-up populations | $ - 0 | 5 | $ - 0 | ||
| Total Contract Cost | $ - 0 |
*Nevada's rating period and/or premium year operates on a calendar year (CY) basis; State Fiscal Year (SFY) operates on a July-June basis. Work performed in CY2025 will consist of working collaboratively with the current Vendor to finalize CY2026 rate building, which will be in progress when the new contract effective date begins. All capitation rate developent work shall conform to the Rate Development Standards and Appropriate Documentation guidance found in most the recently published Medicaid Managed Care Rate Development Guide, available at: https://www.medicaid.gov/medicaid/managed-care/guidance/rate-review-and-rate-guides At the time of RFP publication the most recently published version is 2024-2025.
&"Arial,Bold"&12COST SCHEDULE Managed Care Organizations (MCO) and Dental Benefits Administrator (DBA)
&"Arial,Regular"&10Cost Schedule Proposal &P of &N
Specialty MCO
40DHHS-S3339 - SPECIALTY MANAGED CARE ORGANIZATION (MCO) ACTUARIAL SERVICES
Instructions: Vendor must provide a cost estimate in Column F for the services listed below, as well as the proposed hourly rates.
| Should travel be needed under the scope of services, the cost of travel shall be inclusive in the overall deliverable costs. If travel costs exceed the overall deliverable cost, Contractor shall be responsible for the difference. | ||||||||
| Task Area - Reference Scope of Work for details pertaining to each item. | Cost per Deliverable | Years of Contract Term | Annual Cost | |||||
| Capitation Rate Setting* | ||||||||
| A. | Capitation Rate Development: | |||||||
| Methodology, Calculations, Preliminary Rate Estimates, Follow up | $ - 0 | 5 | $ - 0 | |||||
| B. | Capitation Rate Modifications: | |||||||
| Risk Mitigation, Analysis | $ - 0 | 5 | $ - 0 | |||||
| General Obligations: Actuarial Soundness, Project Management, Appeals, Data; Legislative |
Session Fiscal Impact Requests.
Total Contract Cost $ - 0
*Nevada's rating period and/or premium year operates on a calendar year (CY) basis; State Fiscal Year (SFY) operates on a July-June basis. Work performed in CY2025 will consist of working collaboratively with the current Vendor to finalize CY2026 rate building, which will be in progress when the new contract effective date begins.
NEMT
40DHHS-S3339 - NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) ACTUARIAL SERVICES
Instructions: Vendor must provide a cost estimate in Column F for the services listed below, as well as the proposed hourly rates.
| Should travel be needed under the scope of services, the cost of travel shall be inclusive in the overall deliverable costs. If travel costs exceed the overall deliverable cost, Contractor shall be responsible for the difference. | ||||||||
| Task Area - Reference Scope of Work for details pertaining to each item. | Cost per Deliverable | Years of Contract Term | Annual Cost | |||||
| Capitation Rate Setting* | ||||||||
| A. | Capitation Rate Development: | |||||||
| Methodology, Calculations, Preliminary Rate Estimates, Follow up | $ - 0 | 5 | $ - 0 | |||||
| B. | Capitation Rate Modificationa and Adjustments: | |||||||
| Interim Prospective Risk Adjustments, Risk Adjustments, Risk Mitigation, Analysis | $ - 0 | 5 | $ - 0 | |||||
| General Obligations: Actuarial Soundness, Project Management, Appeals, Data; Legislative |
Session Fiscal Impact Requests.
Total Contract Cost $ - 0
*Nevada's rating period and/or premium year operates on a calendar year (CY) basis; State Fiscal Year (SFY) operates on a July-June basis. Work performed in CY2025 will consist of working collaboratively with the current Vendor to finalize CY2026 rate building, which will be in progress when the new contract effective date begins.
Proposed Resource Pool
40DHHS-S3339 - RESOURCE POOL
Each vendor that receives an award under this solicitation will also receive an award to serve as a qualified vendor eligible for future contracts with DHCFP as part of a resource pool of contracted actuarial and financial vendors that can provide ad hoc services to support DHCFP activities with respect to actuarial and financial projects as requested by the DHCFP as outlined in the Scope of Work Section 4. All requests for ad services for the resource pool will follow a work order process defined by DHCFP.
Instructions: Vendor must provide a proposed composite rate which is a combination of each of the staff professional levels described below. Vendor should provide a proposed hourly rate and associated weight or level of effort to each staff professional level below. Weight should equal 100%.
| Proposed Ad Hoc Hourly Rates | |||
| Staff Professional Level | Description | Weight(%) | Proposed Rate |
| Principal (FSA) | An actuary with highly specialized skills that are in high demand | ||
| Reviewing/Managing Actuary (FSA) | An actuary, who is qualified in the applicable practice area, has signature authority in that area of practice who oversees the project. | ||
| Consulting Actuaries (all) (ASA) | An actuary who is qualified in the applicable practice area with signature authority in that area of practice. | ||
| Actuarial Analyst/Trainee (all) | An individual who is non-credentialed and working under the direction of an actuary who is qualified in the applicable practice area. | ||
| Non-Actuarial Support | An individual who is providing administrative support. | ||
| Proposed composite rate | 0% | $ - 0 |
| Total Annual Cost | Cost Per Hour | Hours per Year | Annual Cost |
| Proposed Ad Hoc Stuff | $ - 0 | $ - 0 | |
| Total Costs | $ - 0 |
Summary
| MANAGED CARE ORGANIZATIONS (MCOs) & DENTAL BENEFITS ADMINISTRATOR (DBA) ACTUARIAL SERVICES | ||
| This summary relects the total costs of the four elements within the SOW and effective dates of services. | ||
| Scope of Work | Total Cost | |
| Medical MCO & DBA | $ - 0 | Do not modify formulas |
Speciality MCO $ - 0
NEMT $ - 0
Resource Pool $ - 0
Projected total costs of the contracts terms $ - 0
File details come from the government source that posted it. Updated .