Attachment F - Technical Proposal Questions_02.10.2026.docx

Attachment F – Technical Proposal Questions This Request for Proposal (RFP) attachment outlines the Technical Proposal Questions that Vendors must answer in their Technical Proposal responding to this Solicitation. Vendors will be evaluated on the quality and completeness of their responses to the questions, and responses should demonstrate the Vendor’s full understanding of all contractual requirements contained in Attachment E – Scope of Work.

The Vendor must provide a response to each question in this attachment. As prompted by the question, Vendors are expected to discuss their:

1. Approach to addressing the issue in the narrative question, highlighting how their approach will (a) allow the Vendor to fulfill the contractual requirements, (b) align with outlined program goals, and (c) represent innovation and/or best practices;

1. Capabilities to implement their proposed approach, which could include organizational structure, staffing resources, operational infrastructure, intended approach to engaging subcontractors, established operational protocols, and technology infrastructure and resources (e.g., IT systems and system capabilities); and

1. Experience related to the issue in the narrative question that illustrates how the Vendor has successfully addressed this issue in contexts comparable to those required of the Specialty Medicaid Managed Care Plan.

Vendors should not assume that the individuals involved in the evaluation process are familiar with any current or past work activities with the State.

Responses to each question should be complete and may not reference responses provided to other questions in the Technical Proposal.

When citing relevant experience, the Vendor must clearly state what coverage program(s), state(s), and year(s) the experience comes from and how it will translate to the Specialty Managed Care Plan (e.g., total Enrollees in coverage program, covered populations, covered services) and to the issues discussed in the question. In responding to a question, if the Vendor will use a subcontractor to fulfill any part of the response, the Vendor must provide the name of the subcontractor and explain how the subcontractor’s performance will be no less effective than if done by the Vendor. Vendors with experience delivering Medicaid Managed Care are strongly encouraged to use Medicaid examples whenever possible; Vendors without relevant Medicaid experience may provide examples from a comparable low-income insurance program.

When providing data in a response, Vendors must include a brief description of each data measure, why it is a relevant measure of impact for the example provided, and a brief explanation of the data methodology (including sample size, where appropriate).

Vendors must adhere to the formatting requirements outlined in Section 9.2 of the RFP and the page limits per question stated below. The evaluation committee will not consider or score any pages submitted beyond the stated page limit for any given question. The question page limits and maximum number of points available for each question are outlined in the table below.

Joe Lombardo Governor

NEVADA HEALTH AUTHORITY

NEVADA MEDICAID

4070 Silver Sage Drive Carson City, Nevada 89701

NVHA.NV.GOV

Stacie Weeks, Director

Ann Jensen, Administrator

Technical Proposal Question Scoring:

(Maximum points, not including bonus points)

A. Overall Experience

B. Care Management

C. Provider Network

D. Service Delivery

*Bonus *Bonus

Technical Proposal Questions Overall Experience

Responses must include a summary table with the information listed below for each state where the Vendor served as a similar specialty plan and for each state the Vendor referenced in its narrative response to the requested information above:

· Name of state/state program;

· Start and end date;

· Delivery model (e.g., MCO, PIHP);

· Services covered under the contract (physical and behavioral health, pharmacy, transportation, etc.);

· Covered population(s);

· Average number of member months for the most recent twelve (12) months of the contract (or most recent period if the contract has been in place less than twelve [12] months) of the comparable population;

· Instances of sanctions under 42 CFR § 438.702 due to non-compliance under the Medicaid managed care contract including monetary sanctions and non-monetary sanctions (e.g., termination, enrollment penalties, corrective action plans [imposed by the State or other regulator and by the EQRO], suspensions, or non-renewal). Monetary sanctions must be included without regard to the amount of the sanction;

· Data on administrative metrics, including any available data related to concerns raised by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) regarding denials and partial approvals of covered services. This includes information from OIG audits, inquiries, reviews, or reports on utilization management, prior authorization, or access to care pertaining to both open and closed matters; and

· Data on access to care and performance on HEDIS metrics applicable to the population served.

Care Management

1. Care management system experience

Describe Vendor’s experience with the development and implementation of high-performing, comprehensive care management programs for similar populations. Describe how the Vendor will leverage this experience to meet Scope of Work and the Department of Justice (DOJ) Settlement Agreement requirements.

Responses must include details and supporting data on the following components:

· Experience collaborating with Network Provider Care Management Entities (CMEs) and other Network Providers including Primary Care Physicians and other specialists;

· Processes the Vendor will utilize to stratify care management models;

· Strategies to support the State’s implementation of statewide screening and assessment tools for behavioral health needs; and

· Process to ensure adequate data exchange between the CME, Specialty Plan, and Network Providers as required by the RFP.

Responses must include two examples with supporting data from other states of how the Vendor has partnered with these agency partners to ensure successful care management outcomes.

Provider Network

The response should include:

· The Vendor’s understanding of current network challenges and strategies to address them.

· How the Vendor will ensure timely access to:

· The full continuum of behavioral health services, from those provided in home, school, and other community-based settings to high acuity out-of-home settings;

· Care Management delivered by CMEs with the TCM expertise and capacity to meet the population’s behavioral health needs;

· Comprehensive physical health services, including pregnancy-related services for female Enrollees; and

· Specialized physical and behavioral health services delivered for Enrollees with dual diagnoses and complex health conditions.

· How the Vendor will ensure compliance with federal and State network adequacy requirements, including provider capacity and appointment availability.

The response should include:

· The Vendor’s understanding of current network challenges in rural and frontier counties of Nevada and strategies to address them.

· How the Vendor will ensure timely access to:

· The full continuum of behavioral health services, from those provided in home, school, and other community-based settings to high acuity out-of-home settings;

· Care Management delivered by CMEs with the TCM expertise and capacity to meet the population’s behavioral health needs;

· Comprehensive physical health services, including pregnancy-related services for female Enrollees; and

· Specialized physical and behavioral health services delivered for Enrollees with dual diagnoses and complex health conditions.

· How the Vendor will ensure compliance with federal and State network adequacy requirements, including provider capacity and appointment availability.

Response should include two examples in which the Vendor implemented a system-wide approach to delivering high-quality, evidence-based, trauma-informed comprehensive health services to similar populations and data supporting improved outcomes.

Service Delivery

Responses must include detail on the responsibilities of Vendor’s Network Primary Care Providers, the Vendor’s Care Management Program, and coordination with other providers to deliver EPSDT services, improve outcomes, and track and report on EPSDT services as required. Responses must separately describe the Vendor’s approach for: (1) the Urban Clark and Urban Washoe Service Areas; and (2) The Rural Service Area.

Responses must include two examples of how the Vendor expanded and strengthened the delivery of these services for similar populations as those eligible for the Specialty Plan.

3. New Investments in Non-Covered Supports and Services

*Scored as Bonus Describe the Vendor’s approach to investing in non-Medicaid covered supports and services for the Specialty Managed Care Plan Enrollees and their families and/or caregivers in a manner that addresses the health-related social needs of the Enrollee. This may include a child and family flex fund for non-covered services, supported employment programs, housing supports and services, nutrition and meal services and supports, and childcare assistance.

Responses must include a proposed approach for how the Vendor will invest in non-Medicaid services and supports, offer value added benefits and in lieu of services to achieve the program goals.

Complex Case Scenarios

Zoe also has a history of intermittent polysubstance use, primarily consisting of the misuse of prescription opioids that she has obtained from peers at school, cannabis, and alcohol use. Zoe is enrolled in an intensive outpatient program to address her substance use, providing group therapy and individual counseling, relapse prevention education, and random drug testing. Her engagement in this program has been inconsistent. Random drug screenings have primarily been negative; however, occasional screenings have been positive indicating intermittent use despite program participation.

Zoe is currently placed in a psychiatric residential treatment facility (PRTF) after a crisis involving self-harm. The Care Management Entity (CME) Wraparound Facilitator has been collaborating with the facility and Zoe’s Child and Family Team—including Zoe, Zoe’s foster parents, child welfare agency representatives, school system representatives, PRTF staff, and community-based providers—to plan for Zoe’s discharge and transition back to Zoe’s foster parents and the community. Unexpectedly, a recent visit to her PCP now reveals that Zoe is pregnant, triggering the need to revisit discharge planning.

Zoe has expressed a desire to keep the baby but is anxious about the future and fears that child welfare will “just take my baby away.” Zoe’s foster parents care deeply for Zoe but feel unprepared and unqualified to support both Zoe and her baby.

Describe the Vendor’s approach to identifying and meeting the short term and longer-term comprehensive needs of this member, including medical, behavioral, pregnancy-related, and social services and supports. Include how the Vendor will monitor, evaluate and adjust care management activities to achieve optimal outcomes for Zoe.

Tony has been assessed as having a Serious Emotional Disturbance (SED) related to ADHD and Fetal Alcohol Spectrum Disorder, along with a moderate intellectual disability. Tony receives special education services and has an Individualized Education Plan (IEP) that includes a self-contained classroom for much of the day, speech therapy, and occupational therapy. A behavioral aide supports Tony during the school day, but the teacher reports that even with this support, Tony’s needs are escalating. Recently, Tony hit a staff member and attempted to run out of the building. The school has contacted Tony’s parents to schedule a meeting to discuss revisiting the IEP to address these escalating behaviors.

Tony’s parents are experiencing similar challenges at home with Tony’s intense emotional outbursts and property destruction. Before and after school transitions and any changes in routine are particularly difficult. Tony’s behaviors are unpredictable and exhausting to manage. Tony receives 1915(c) waiver services and service coordination through the Aging and Disability Services Division. He also receives outpatient behavioral health services covered under the Specialty Plan, but has missed several outpatient visits due to transportation barriers and scheduling issues.

Due to a change in Tony’s mom’s work schedule that will start in two weeks, Tony will need after-school care. Tony’s parents have been looking for after-school programs, but there are a limited number in their community and those that operate near them have not been willing to accept Tony because of behavioral challenges. Tony’s parents do not know what to do because Tony cannot be on his own and the family needs both incomes to meet living expenses. In addition, his family recognizes this will be a big change for Tony at a time when his behaviors are already challenging.

While Tony’s parents appreciate the help that has been given to Tony and their family, they desperately need help with finding after-school care and need more help to stabilize Tony’s behavior to keep Tony and others safe while meeting Tony’s therapeutic needs. They have also shared that they are often unsure about who to reach out to when they need help.

Describe the Vendor’s approach to identifying and meeting the needs of Tony and his family. Include the Vendor’s approach to monitoring and adjusting care management to achieve improved outcomes and satisfaction for the member and his family.

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