Appendix_7_7_EAP_WL_MHSA_Utilization_Revised.xlsx

This file is a utilization data appendix supporting Tennessee's Department of Finance and Administration procurement for integrated Employee Assistance Program (EAP) and Behavioral Health Organization (BHO) services across three state insurance plans. The procurement encompasses comprehensive network administration, utilization management, claims adjudication, call center services, and benefits communication for approximately 300,000 covered lives distributed across the State Plan (147,000 covered lives), the Local Education Plan (128,000 covered lives), and the Local Government Plan (26,000 covered lives). The RFP was issued on October 8, 2025, with written questions due October 22, 2025, and November 19, 2025, and a response deadline of December 19, 2025. The state anticipates completing technical evaluations by January 29, 2026, cost proposal scoring on January 30, 2026, and negotiations scheduled for February 9-11, 2026. The contract will be structured as an 86-month engagement comprising eight months of implementation, 60 months of service delivery from January 1, 2027 through December 31, 2031, and an 18-month claims runout period.

The compensation structure utilizes a per-employee-per-month (PEPM) administrative fee model. The state self-funds medical, pharmacy, and behavioral health claims totaling approximately $976 million annually across all three plans, demonstrating substantial financial commitment. Successful vendors must maintain NCQA accreditation as a Managed Behavioral Healthcare Organization and URAC accreditation for utilization management programs, demonstrate financial stability, and provide evidence of managing employer populations exceeding 10,000 members with claims adjudication experience exceeding $10 million annually for at least two clients. The incumbent contractor will manage transition of existing members and services at no additional cost to the state. Contractors must carry $5 million in cyber liability insurance and comply with HIPAA, HITECH, and state security requirements, including annual SOC 2 Type 2 examinations and penetration testing. Performance guarantees include liquidated damages ranging from $1,000 to $75,000 per incident.