MHCC 27-004 Actuarial Consulting - Limiting Prior Authorization for Coverage of Direct-Acting Antivirals for Hepatitis C.pdf

SMALL PROCUREMENT

REQUEST FOR PROPOSALS (RFP)

Actuarial Consulting on the Impact of Limiting Prior Authorization for Coverage of Direct-acting Antivirals for Hepatitis C

PROCUREMENT ID NUMBER: MHCC 26-005

July 22, 2026

Joan Gelrud, RN,MSN, CPHQ,FACHE Chair

Douglas Jacobs

EXECUTIVE DIRECTOR

i

STATE OF MARYLAND

MARYLAND HEALTH CARE COMMISSION

RFP KEY INFORMATION SUMMARY SHEET

Request for Proposals: Actuarial Consulting on the Impact of Limiting Prior Authorization for Coverage of Direct-acting Antivirals for Hepatitis C

Solicitation Number: MHCC 27-004

RFP Issue Date: July 22, 2026

RFP Issuing Office: Maryland Health Care Commission

Procurement Officer: Andrea Allen 4160 Patterson Avenue Baltimore, Maryland 21215 Phone: 410-764-8791 email: andrea.allen@maryland.gov

Contract Monitor: Name: Jason Caplan Title: Chief of Special Projects Center Phone: 410-764-3460 Email: Jason.caplan3@maryland.gov

Proposals are to be sent to: Via eMMA only

Proposal Due (Closing): August 14, 2026

Contract Type: Fixed Price: Limit $65,000

Contract Term: August 2026 - January 2027

SBR Designation: No mailto:nicole.majewski@maryland.gov

VENDOR FEEDBACK FORM

To help us improve the quality of State solicitations, and to make our procurement process more responsive and business friendly, please provide comments and suggestions regarding this solicitation. Please return your comments with your response. If you have chosen not to respond to this solicitation, please email or fax this completed form to the attention of the Procurement Officer (see Key Information Summary Sheet below for contact information).

Title: Actuarial Consulting on the Impact of Limiting Prior Authorization for Coverage of Direct-acting Antivirals for Hepatitis C

Solicitation No: MHCC 27-004

1. If you have chosen not to respond to this solicitation, please indicate the reason(s) below:

� Other commitments preclude our participation at this time � The subject of the solicitation is not something we ordinarily provide � We are inexperienced in the work/commodities required � Specifications are unclear, too restrictive, etc. (Explain in REMARKS section) � The scope of work is beyond our present capacity � Doing business with the State is simply too complicated. (Explain in REMARKS section) � We cannot be competitive. (Explain in REMARKS section) � Time allotted for completion of the Proposal is insufficient � Start-up time is insufficient � Proposal requirements (other than specifications) are unreasonable or too risky

(Explain in REMARKS section) � Prior State of Maryland contract experience was unprofitable or otherwise unsatisfactory. (Explain in REMARKS section) � Other:

2. If you have submitted a response to this solicitation, but wish to offer suggestions or express concerns, please use the REMARKS section below. (Attach additional pages as needed.)

REMARKS:______________________________________________________________________

Vendor Name: ________________________________ Date: _______________________

Contact Person: _________________________________ Phone (____) _____ - ______________

Address: ______________________________________________________________________

Email Address: ________________________________________________________________

Table of Contents

SECTION 1 - GENERAL INFORMATION 2

SECTION 2 – EXPERIENCE AND PERSONNEL 6

SECTION 3 – SCOPE OF WORK 7

SECTION 4 – PROPOSAL FORMAT 16

SECTION 5 - EVALUATION AND SELECTION PROCESS 19

Attachment A – Contract 22

1. Definitions 22

2. Scope of Contract 22

3. Period of Performance 23

4. Consideration and Payment 23

Attachment B – Financial Proposal 31

Attachment C – Bid/Proposal Affidavit 32

Attachment D – Contract Affidavit 32

Attachment E – Living Wage Affidavit (if applicable) 32

SECTION 1 - GENERAL INFORMATION

1.1 Summary Statement

1.1.1 The Maryland Health Care Commission (MHCC or Commission) is an independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access in a rapidly changing health care environment by providing timely and accurate information on availability, cost, and quality of services to policy makers, purchasers, providers, and the public. The Commission's vision for Maryland is to ensure that informed consumers hold the health care system accountable and have access to affordable and appropriate health care services through programs that serve as national models.

MHCC is seeking a contractor who can successfully deliver health care related actuarial services to assist the Commission in completing a legislative requirement to conduct a social, medical, and financial impact analysis of coverage and review of the cost of requiring health insurers, nonprofit health service plans, and health maintenance organizations, MCOs, and Medicaid to Limit Prior Authorization for coverage of direct-acting antivirals for Hepatitis C.

1.1.2 The Commission intends to obtain services, as specified in this RFP, from a Contract between the selected Offeror and the State. The anticipated duration of services to be provided under this Contract is August 22nd, 2026 - January 31st, 2027.

1.1.3 The Commission intends to make a single award as a result of this RFP.

1.3 Procurement Method

This solicitation shall be made in accordance with the competitive sealed proposals regulations described in COMAR 21.05.03.

1.4 Procurement Officer

The sole point of contact in the State for the purposes of this solicitation prior to the award of any Contract is the Procurement Officer stated on the

1.6 eMaryland Marketplace Advantage

Each Offeror is requested to indicate its eMaryland Marketplace Advantage (eMMA) vendor number in the Transmittal Letter (cover letter) submitted at the time of its Proposal submission to this RFP.

eMMA is an electronic commerce system administered by the Maryland Commission of General Services. The RFP and associated materials, the solicitation and summary of the Pre-Proposal Conference, Offeror questions and the Procurement Officer’s responses, addenda, and other solicitation-related information will be provided via eMMA.

In order to receive a contract award, a vendor must be registered on eMMA. Registration is free.

Go to https://emma.maryland.gov/, click on “Register” to begin the process, and then follow the prompts.

1.7 Verification of Registration and Tax Payment

Before a business entity can do business in the State, it must be registered with the State Department of Assessments and Taxation (SDAT). SDAT is located at State Office Building, Room 803, 301 West Preston Street, Baltimore, Maryland 21201. For registration information, visit https://www.egov.maryland.gov/businessexpress.

It is strongly recommended that any potential Offeror complete registration prior to the Proposal due date and time. The Offeror’s failure to complete registration with SDAT may disqualify an otherwise successful Offeror from final consideration and recommendation for Contract award.

1.8 Questions

Written questions from prospective Offerors will be accepted by the Procurement Officer.

Questions to the Procurement Officer shall be submitted via email to the following email address:

(andrea.allen@maryland.gov). Please identify in the subject line the Solicitation Number and Title.

Questions are requested to be submitted at least 5 (five) days prior to the Proposal due date. The Procurement Officer, based on the availability of time to research and communicate an answer, shall decide whether an answer can be given before the Proposal due date.

1.9 Proposals Due (Closing) Date and Time

Proposals must be uploaded to eMMA no later than 4:00 pm Local Time on Friday, August 14th, 2026, in order to be considered.

Requests for an extension of this time or date will not be granted. Proposals received after the due date and time listed in this section will not be considered. Questions regarding this solicitation should be directed (By email only, no phone calls will be accepted) to the Procurement Officer.

1.10 Bid/Proposal Affidavit

A Proposal submitted by the Offeror must be accompanied by a completed Bid/Proposal Affidavit.

A copy of this Affidavit is included as Attachment C of this RFP.

1.11 Contract Affidavit

All Offerors are advised that if a Contract is awarded as a result of this solicitation, the successful Offeror will be required to complete a Contract Affidavit. A copy of this Affidavit is included for informational purposes as Attachment D of this RFP. This Affidavit must be provided within five

(5) Business Days of notification of recommended award. For purposes of completing Section “B” of this Affidavit (Certification of Registration or Qualification with the State Department of Assessments and Taxation), a business entity that is organized outside of the State of Maryland is considered a “foreign” business.

https://www.egov.maryland.gov/businessexpress

1.12 Living Wage Affidavit

A. Maryland law requires that contractors meeting certain conditions pay a living wage to covered employees on State service contracts over $100,000. Maryland Code Ann., State Finance and Procurement Article, § 18-101 et al. The Commissioner of Labor and Industry at the Maryland Department of Labor requires that a contractor subject to the Living Wage law submit payroll records for covered employees and a signed statement indicating that it paid a living wage to covered employees; or receive a waiver from Living Wage reporting requirements. See COMAR 21.11.10.05.

B. If subject to the Living Wage law, Contractor agrees that it will abide by all Living Wage law requirements, including but not limited to reporting requirements in COMAR

21.11.10.05. Contractor understands that failure of Contractor to provide such documents is a material breach of the terms and conditions and may result in Contract termination, disqualification by the State from participating in State contracts, and other sanctions. Information pertaining to reporting obligations may be found by going to the Maryland Department of Labor website http://www.dllr.state.md.us/labor/prev/livingwage.shtml.

C. Additional information regarding the State’s living wage requirement is contained in Attachment E. Offerors must complete and submit the Maryland Living Wage Requirements Affidavit of Agreement (Attachment E-1) with their Proposals. If the Offeror fails to complete and submit the required documentation, the State may determine the Offeror to not be responsible under State law.

D. Contractors and subcontractors subject to the Living Wage Law shall pay each covered employee at least the minimum amount set by law for the applicable Tier area. The specific living wage rate is determined by whether a majority of services take place in a Tier 1 Area or a Tier 2 Area of the State. The specific Living Wage rate is determined by whether a majority of services take place in a Tier 1 Area or Tier 2 Area of the State.

1) The Tier 1 Area includes Montgomery, Prince George’s, Howard, Anne Arundel and Baltimore Counties, and Baltimore City. The Tier 2 Area includes any county in the State not included in the Tier 1 Area. In the event that the employees who perform the services are not located in the State, the head of the unit responsible for a State Contract pursuant to §18-102(d) of the State Finance and Procurement Article shall assign the tier based upon where the recipients of the services are located. If the Contractor provides more than 50% of the services from an out-of- State location, the State agency determines the wage tier based on where the majority of the service recipients are located. In this circumstance, the Contract will be determined to be a Tier (enter “1” or “2,” depending on where the majority of the service recipients are located) Contract.

2) The Contract will be determined to be a Tier 1 Contract or a Tier 2 Contract depending on the location(s) from which the Contractor provides 50% or more of the services. The Offeror must identify in its Proposal the location(s) from which services will be provided, including the location(s) from which 50% or more of the Contract services will be provided.

http://www.dllr.state.md.us/labor/prev/livingwage.shtml

3) If the Contractor provides 50% or more of the services from a location(s) in a Tier 1 jurisdiction(s) the Contract will be a Tier 1 Contract.

4) If the Contractor provides 50% or more of the services from a location(s) in a Tier 2 jurisdiction(s), the Contract will be a Tier 2 Contract.

E. If the Contractor provides more than 50% of the services from an out-of-State location, the State agency determines the wage tier based on where the majority of the service recipients are located. See COMAR 21.11.10.07.

F. The Offeror shall identify in the Proposal the location from which services will be provided.

NOTE: Whereas the Living Wage may change annually, the Contract price will not change because of a Living Wage change or a change in the State minimum wage.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

SECTION 2 – EXPERIENCE AND PERSONNEL

2.1 Minimum Qualifications

The following experience is required and will be evaluated as part of the Technical Proposal:

The Offeror shall have at least five (5) years of demonstrated experience providing the following work for state or federal clients within the last five (5) years.

a. Experience completing actuarial estimates on coverage and reimbursement requirements imposed on carriers.

b. Experience assessing the clinical benefits to patients of specific health care treatments and medical interventions.

c. Experience analyzing health care claims information from Maryland’s Medical Care Database (also known as an APCD) or a similar data source should be described.

As proof of meeting this requirement, the Offeror shall provide with its Proposal evidence of this experience by submitting summaries and documentation of past training and/or references attesting to the Offeror’s experience.

Three (3) references are preferred. Each reference shall identify the name of the organization, point of contact, and contact number. MHCC shall have the right to contact these or other references of its choosing as part of the evaluation and selection process.

2.2 Personnel

2.2.1 Staffing Design

The Contractor may propose to augment or revise the following list of required personnel. The Contractor must demonstrate how its proposed staff model will complete the tasks in a timely fashion. Proposals must include an hourly rate for the work to be performed and an estimate of the total number of hours required to complete each task.

Labor Category Description

Principal Actuary

Senior Actuary with an ASA or higher and an advanced degree in health economics, statistics, or health policy (Ph.D., MS, or MBA preferred) with at least 10 years of experience, of which at least 5 years include estimating the costs of health benefits. Three (3) additional years of experience may be substituted for the advanced degree requirement.

Actuarial Analyst Actuary (ASA or near ASA) with at least 3 years of experience analyzing the costs of health care coverage for private or public payers.

Note: The Contractor shall propose a single individual as the Principal Actuary. The Contractor may offer multiple individuals as actuarial analysts.

SECTION 3 – SCOPE OF WORK

3.1 Background and Purpose

3.1.1 Purpose

The Maryland Health Care Commission (MHCC) seeks a Contractor to conduct an analysis which requires health insurers, nonprofit health service plans, and health maintenance organizations, medicaid and MCOs on the Impact of Limiting Prior Authorization for coverage of direct-acting antivirals for Hepatitis C. The Contractor shall deliver healthcare related actuarial services to perform the tasks described under Section 3.2, Scope of Work requirements.

3.1.2 Background

The MHCC is a 15-member independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access in a rapidly changing health care environment by providing timely and accurate information on availability, cost, and quality of services to policymakers, purchasers, providers, and the public. The MHCC's vision for Maryland is to ensure that informed consumers hold the health care system accountable and have access to affordable and appropriate health care services through programs that serve as models for the nation. The MHCC is comprised of four Centers that collectively plan, evaluate, and regulate health care in Maryland.1

Insurance Article §15–1501, Annotated Code of Maryland, requires that the Maryland Health Care Commission (MHCC) annually assess the medical, social, and financial impact of proposed mandated health insurance services that failed to pass during the preceding legislative session or as requested by a Legislator or Legislative Committee by July 1 of each year. The assessment reports are due to the General Assembly annually by December 31st.

The Maryland General Assembly, via letter on June 23, 2026, has requested that MHCC study the cost of Limiting Prior Authorization for coverage of direct-acting antivirals for Hepatitis C for health insurers, nonprofit health service plans, and health maintenance organizations, MCOs, and Medicaid. More specifically, the General Assembly would like to understand the implications of;

● Prohibiting PA for all generic Direct Acting Antiviral (DAAs) for treatment naïve patients (i.e. haven’t previously been treated with a DAA hep c regimen) – PA would still be permitted for brand name drugs

● Prohibiting PA for all generic pan-genotypic DAAs for treatment naïve patients

● Prohibiting PA for at least 1 generic DAA for treatment naïve patients

1 More information on the four Centers is available at:

mhcc.maryland.gov/mhcc/pages/home/mhcc_overview/mhcc_overview.aspx.

https://mhcc.maryland.gov/mhcc/pages/home/mhcc_overview/mhcc_overview.aspx

● For each of the above proposals would like to understand how limiting the prohibition to patients based on cirrhosis status would impact the proposal (i.e., patients w/o cirrhosis, patients with compensated cirrhosis, patients with decompensated cirrhosis).

3.2 Scope of Work – Requirements

A. Evaluation of the Analysis to Limit Coverage for Prior authorization of direct-acting antivirals for Hepatitis C. The Contractor shall utilize its health care actuaries’ knowledge and experience, proprietary databases, in-house data, carrier surveys, and other externally available data sources to complete this actuarial evaluation, that includes the following:

1. A social evaluation including:

a) the extent to which the coverage and reimbursement requirement (or “the service”) is generally utilized by a significant portion of the population;

b) the extent to which the insurance coverage is already generally available;

c) the extent to which the lack of coverage results in individuals avoiding necessary health care treatments;

d) the extent to which the lack of coverage results in unreasonable financial hardship;

e) the level of public demand for the service;

f) the level of public demand for insurance coverage of the service; and

g) the extent to which the service is covered by self–funded employer groups of employers in the State who employ at least 500 employees.

2. A medical evaluation including:

a) the extent to which the service is generally recognized by the medical community as being effective and efficacious in the treatment of patients;

b) the extent to which the service is generally recognized by the medical community as demonstrated by a review of scientific and peer review literature; and

c) the extent to which the service is generally available and utilized by treating physicians.

3. A financial evaluation including an estimate of both the marginal cost and the full cost of requiring carriers to provide this coverage and reimbursement requirement, including:

a) the extent to which the coverage will increase or decrease the cost of the service;

b) the extent to which the coverage will increase the appropriate use of the service;

c) the extent to which the mandated service will be a substitute for a more expensive service;

d) the extent to which the coverage will increase or decrease the administrative expenses of carriers, and the premium and administrative expenses of policy holders and contract holders;

e) the impact of this coverage on the total cost of health care; and

f) the impact of all mandated health insurance services on employers’ ability to purchase health benefits policies meeting their employees’ needs.

4. The Contractor shall conduct carrier surveys to gather information on insurance coverage policies specific to this analysis. MHCC will request that carriers participate in the Contractor’s survey efforts. The Contractor will conduct the survey, assemble the responses, and analyze the survey results.

The Contractor may propose an alternative approach to the carrier surveys.

5. Access to Medical Care Data Base (MCDB) Data.

The Contractor shall specify in its proposal whether it requests direct access to the MCDB, Maryland’s all payer claims database (APCD) to perform analyses on claims data or whether the Contractor proposes that MHCC staff generate analyses from the MCDB.

a) If the Contractor requests access to the MCDB to conduct its own analyses, the

Contractor shall review and sign the attached Data Use Agreement (DUA) in attachment F.

b) If the Contractor requests that MHCC staff will be available to generate analyses from the MCDB, the Contractor shall provide all necessary codes (ICD and/or CPT/HCPCS) and data table shells for the data outputs. MHCC staff reserves the right to decline requests from the Contractor that are judged not feasible or that cannot be completed during the duration of the study.

B. Project Management

The Contractor shall:

1. Create and maintain a detailed work plan for all tasks to be completed by the Contractor. The work plan shall be updated monthly or more frequently as requested by MHCC. At a minimum, the work plan shall include:

a) Each major step of the project with specific tasks, milestones, and begin/complete dates;

b) Name(s) and position title(s) of staff members responsible for each task, and the number of hours assigned to each staff member to complete each task; and

c) Resource needs and limitations.

2. Provide MHCC with progress reports bi-weekly and as requested by MHCC; all reports shall be provided in a format acceptable by MHCC and contain, at a minimum:

a) The status of each task;

b) A description of any problems or limitations encountered and solutions to address each problem or limitation;

c) Updates to the work plan, as needed;

d) Key activities accomplished since the last progress report;

e) Key activities that are delayed and for which the complete date noted in the work plan may potentially be missed; and

f) Key activities on the horizon.

3. Meet with MHCC virtually monthly or more frequently as requested by MHCC to discuss pertinent matters related to the Framework.

C. Framework and Rationale – Report

1. The Contractor shall develop a detailed outline for the Framework and Rationale that minimally includes an introduction (noting the driver for developing a Framework and current landscape of health payment reform), approach and limitations, key components, and supporting rationale.

a) The outline should be written in a clear and concise style that is understandable by stakeholders with varying degrees of technical background. To maximize understanding of the content for a non-technical audience:

i. Include technical explanations essential to understanding the Framework (using footnotes or visuals when appropriate);

ii. limit the use of acronyms that are not frequently repeated and provide explanation ("learn more " details for readers who wish to learn more) for all matters essential to understanding the Framework.

b) The Contractor shall complete a preliminary draft outline in accordance with the deliverables in Section 3.3.1.

c) The Contractor shall update the draft outline based on data analysis and feedback from payers and providers in accordance with the deliverables in Section 3.3.1.

d) The Contractor shall complete a final draft outline in accordance with the deliverables in Section 3.3.1.

e) Each iteration of the outline shall incorporate MHCCs’ requested revisions.

2. The Contractor shall create a report that is of academic quality, including literature, data, and relevant appendices, and be consistent with the outline approved by MHCC.

a) The report shall include a Highlights page with;

i. 3-5 bullet points on the medical impact

ii. 3-5 bullet points on the social impact

iii. 3-5 bullet points on the financial impact, and;

iv. a table of the financial impact (examples below)

Financial Impact by Range Example # 1 - For all assumptions please provide the low end of the estimated cost, the middle estimated cost and the high end of the estimated cost.

Assumption Low Best Estimate High

Prevalence (if applicable)

Percent of population affected

Premium Cost PMPM Increase due to Legislation

Premium Cost PMPM % Increase due to

Total Premium Cost Increase due to

Example #2 - For all assumptions please provide a breakdown of the %s and costs by type of coverage.

Assumption Individua l

Small Group

Fully Insured Large Group

Totally Fully Insured Commercial

State Health Plan

Medicaid

Prevalence % % % % % % %

Percent of population affected

Premium Cost

PMPM

Increase due to Legislation

Premium Cost

PMPM %

Increase due to Legislation

Total Premium Cost Increase due to

b) The Executive Summary shall present the significant findings and recommendations in language understandable to State policymakers, including Maryland General Assembly members participating in two health oversight committees in the Senate and House of Delegates. The Executive Summary shall be organized as part of the overall report and serve as a high-level, stand-alone document.

c) A draft report is due no later than October 30th, 2026.

d) The Contractor shall update the draft report after review and input from MHCC, which may require multiple iterations.

e) The final draft is due by November 20th, 2026.

D. Commission Presentation

The Contractor shall provide a PowerPoint presentation of the key findings from the final report at the Commission’s monthly public meeting scheduled for 1:00 pm Eastern Standard, Thursday, December 17, 2026. A remote presentation using a format established by MHCC, or an in-person presentation is acceptable.

Copies of previous actuarial mandate reports are available on the MHCC website at:

https://mhcc.maryland.gov/mhcc/pages/plr/plr/plr.aspx or from the Contract Monitor.

3.3 Deliverables

3.3.1 Deliverable Descriptions/Acceptance Criteria

In addition to the items identified in the table below, the Contractor may suggest other subtasks, artifacts, or deliverables to improve the quality and success of the assigned tasks.

Deliverables Summary Table*

Deliverable Description Acceptance Criteria Due Date / Frequency https://mhcc.maryland.gov/mhcc/pages/plr/plr/plr.aspx

Integrated Work Plan Microsoft Project schedule demonstrating tasks, task estimates, resource assignments, and dependencies.

Initial Delivery: Day of Kick- Off Meeting

Kick-Off Meeting Virtual At least seven (7) Business Days after initial notification of contract award

Status Reports Microsoft Word Document Bi-Weekly

Work Plan Updates On or before the 10th of each month

Meetings Virtual or Teleconference Monthly or as requested by the Contract Monitor

Framework and Rationale Outline

Microsoft Word Document and a PDF

August 28th, 2026

Draft Report Microsoft Word Document and a PDF

October 30th, 2026 (6 weeks before final presentation)

Final Report Microsoft Word Document and a PDF

November 20th, 2026 (4 weeks before final presentation)

Draft Presentation PowerPoint November 27th, 2026 (3 weeks before final presentation)

Internal Virtual Presentation to MHCC

PowerPoint December 3rd, 2026 (2 weeks before final presentation)

Final Presentation PowerPoint December 10th, 2026 (1 week before final presentation

Present at Commission Meeting

Virtual or In-person 1 pm, Thursday, December 17th, 2026

*The deliverables summary table may not list every contractually required deliverable. Offerors and Contractors should read the RFP thoroughly for all Contract requirements and deliverables.

3.3.2 Minimum Deliverable Quality

The Contractor shall subject each deliverable to its internal quality-control process prior to submitting the deliverable to the State.

Each deliverable shall meet the following minimum acceptance criteria:

1) Be presented in a format appropriate for the subject matter and depth of discussion.

2) Be organized in a manner that presents a logical flow of the deliverable’s content.

3) Represent factual information reasonably expected to have been known at the time of submission.

4) In each section of the deliverable, include only information relevant to that section of the deliverable.

5) Contain content and presentation consistent with industry best practices in terms of deliverable completeness, clarity, and quality.

6) Meets the acceptance criteria applicable to that deliverable, including any State policies, functional or non-functional requirements, or industry standards.

7) Contains no structural errors such as poor grammar, misspellings or incorrect punctuation.

8) Complies with Section 3.4.8 of this RFP regarding Artificial Intelligence Systems.

9) Must contain the date, author, and page numbers. When applicable for a deliverable, a revision table must be included.

10) A draft written deliverable may contain limited structural errors such as incorrect punctuation and shall represent a significant level of completeness toward the associated final written deliverable. The draft written deliverable shall otherwise comply with minimum deliverable quality criteria above.

3.3.3 Digital Accessibility.

The Contractor shall ensure that any final deliverable complies with the digital accessibility requirements under Title II of the Americans with Disabilities Act. The Contractor shall ensure that all final deliverables meet or exceed Web Content Accessibility Guidelines (WCAG) Version 2.1, Level AA.

3.4 Data Ownership, Access, Protection, and Use

3.4.1 Data, databases and derived data products created, collected, manipulated, or directly purchased as part of a RFP are the property of the State. The purchasing State agency is considered the custodian of the data and shall determine the use, access, distribution, and other conditions based on appropriate State statutes and regulations.

3.4.2 The Contractor shall limit access to and possession of State data to only Contractor Personnel whose responsibilities reasonably require such access or possession and shall train such Contractor Personnel on the confidentiality obligations set forth herein.

3.4.3 At no time shall any data or processes – that either belong to or are intended for the use of the State or its officers, agents or employees – be copied, disclosed or retained by the Contractor or any party related to the Contractor for subsequent use in any transaction that does not include the State.

3.4.4 The Contractor shall not use any information collected in connection with the services furnished under the Contract for any purpose other than fulfilling such services.

3.4.5 The Contractor shall ensure a secure environment for all State data and any hardware and software (including but not limited to servers, network and data components) provided or used in connection with the performance of the Contract and shall apply or cause application of appropriate controls so as to maintain such a secure environment (“Security Best Practices”). Such Security Best Practices shall comply with an accepted industry standard, such as the NIST cybersecurity framework.

3.4.6 Apply data encryption to protect Sensitive Data at all times, including in transit, at rest, and also when archived for backup purposes. Unless otherwise directed, the Contractor is responsible for the encryption of all Sensitive Data.

3.4.7 Data Breach Responsibilities

If the Contractor reasonably believes or has actual knowledge of a Data Breach, the Contractor shall, unless otherwise directed:

1. Notify the appropriate State-identified contact within 24 hours by telephone in accordance with the agreed upon security plan or security procedures unless a shorter time is required by applicable law;

2. Cooperate with the State to investigate and resolve the data breach;

3. Promptly implement commercially reasonable remedial measures to remedy the Data Breach; and

4. Document responsive actions taken related to the Data Breach, including any post-incident review of events and actions taken to make changes in business practices in providing the services.

3.4.8 Artificial Intelligence Systems

1) “AI system” means any system, software, sensor, or process that automatically generates outputs including, but not limited to, predictions, recommendations, or decisions that augment or replace human decision-making. This extends to software, hardware, algorithms, and data generated by these systems, used to automate large-scale processes or analyze large data sets.

2) The Contractor shall not use an AI System for any purposes of this Contract without the

State’s express written approval. Any approved use of an AI System shall comply with the State’s Responsible AI Policy.

3.5 Invoicing

3.5.1 All invoices for services shall be signed by the Contractor and emailed to MHCC.Invoice@maryland.gov at the frequency or schedule described in 3.5.3. All invoices shall include the following information:

a) Contractor name;

b) Remittance address;

c) Federal taxpayer identification number (or if sole proprietorship, the individual’s social security number);

d) Invoice period;

e) Invoice date;

f) Invoice number

g) State assigned Contract number;

h) State assigned (Blanket) Purchase Order number(s);

i) Goods or services provided; and

j) Amount due.

Invoices submitted without the required information cannot be processed for payment until the Contractor provides the required information.

3.5.2 The Commission reserves the right to reduce or withhold Contract payment in the event the Contractor does not provide the Commission with all required deliverables within the time frame specified in the Contract or in the event that the Contractor otherwise materially breaches the terms and conditions of the Contract until such time as the Contractor brings itself into full compliance with the Contract. Any action on the part of the Commission, or dispute of action by https://doit.maryland.gov/policies/ai/Pages/maryland-responsible-ai-policy.aspx https://doit.maryland.gov/policies/ai/Pages/maryland-responsible-ai-policy.aspx the Contractor, shall be in accordance with the provisions of Md. Code Ann., State Finance and Procurement Article §§ 15-215 through 15-223 and with COMAR 21.10.02.

3.5.3 Invoice Submission Schedule

The Contractor shall submit invoices for approved deliverables no later than the 15th, in the month following the acceptance of the work by the Commission. The Contractor shall submit each invoice to email MHCC.Invoice@maryland.gov:

SECTION 4 – PROPOSAL FORMAT

4.1 Two Part Submission

Offerors shall submit Proposals in separate volumes:

▪ Volume I – TECHNICAL PROPOSAL

▪ Volume II – FINANCIAL PROPOSAL

4.2 Proposals

4.2.1 Offerors shall provide their Proposals in two separate envelopes through eMMA following the Quick Reference Guides (QRG) labeled “5 - eMMA QRG Responding to Solicitations (RFP)” for double envelope submissions.

4.2.2 Proposals delivered by facsimile and email shall not be considered.

4.2.3 Provide no pricing information in the Technical Proposal. Provide no pricing information on the media submitted in the Technical Proposal.

4.2.4 The Procurement Officer must receive all electronic Proposal material by the RFP due date and time specified in the Key Information Summary Sheet. Requests for extension of this date or time will not be granted. Except as provided in COMAR 21.05.03.02F, Proposals received by the Procurement Officer after the due date will not be considered.

4.2.5 Volume I - Technical Proposal

NOTE: Omit all pricing information from the Technical Proposal (Volume I). Include pricing information only in the Financial Proposal (Volume II).

A. Transmittal Letter

A transmittal letter prepared on the Offeror’s business stationery is to accompany the proposal.

The letter MUST be signed by an individual who is authorized to bind his/her firm to all statements, including services and prices contained in the proposal. The transmittal letter should include the following:

1) Name and address of the Offeror;

2) Name, title, email address, and telephone number of primary contact for the Offeror;

3) Solicitation Title and Solicitation Number that the Proposal is in response to;

4) Signature, typed name, and title of an individual authorized to commit the Offeror to its Proposal;

5) Federal Employer Identification Number (FEIN) of the Offeror, or if a single individual, that individual’s Social Security Number (SSN);

6) Offeror’s eMaryland Marketplace (eMM) number; and

7) Offeror’s Small Business Reserve (SBR) certification number (if applicable);

8) Offeror’s Minority Business Enterprise (MBE) certification number (if applicable); and

9) Offeror’s Veteran-Owned Small Business Enterprise (VSBE) certification number (if applicable).

B. Offeror Qualifications and Capabilities

The Offeror shall include information on past experience with similar projects and services including information in support of the Offeror Experience criteria in Section 2 and shall include the following information:

1) The number of years the Offeror has provided the similar goods and services;

2) The number of clients/customers and geographic locations that the Offeror currently serves;

3) An organizational chart that identifies the complete structure of the Offeror including any parent company, headquarters, regional offices, and subsidiaries of the Offeror.

4) At least three (3) references from customers who are capable of documenting the Offeror’s ability to provide the goods and services specified in this RFP. Each reference shall be from a client for whom the Offeror has provided goods and services within the past five (5) years and shall include the following information:

a. Name of client organization;

b. Name, title, telephone number, and email address of point of contact for client organization; and

c. Value, type, duration, and description of goods and services provided.

C. Experience and Qualifications of Proposed Staff

The Offeror shall identify the qualifications and types of staff proposed to be utilized under the Contract including information in support of the Personnel Experience criteria in Section 2.

Specifically, the Offeror shall:

1) Describe in detail how the proposed staff’s experience and qualifications relate to their specific responsibilities, including any staff of proposed subcontractor(s), as detailed in the Work Plan.

2) Include individual resumes for Key Personnel, including Key Personnel for any proposed subcontractor(s), who are to be assigned to the project if the Offeror is awarded the Contract. Each resume should include the amount of experience the individual has had relative to the Scope of Work set forth in this solicitation.

D. Offeror Technical Response, in 15 pages or less, to RFP Requirements

1) Statement of the Problem

The Offeror shall demonstrate that the Offeror clearly understands MHCC’s objectives and goals with respect to the work that is the subject of this solicitation. The Offeror shall also demonstrate an understanding of the requirements of this solicitation.

2) Include Disclosure of Conflicts or Potential Conflicts of Interest

The Contractor shall disclose any existing contract that it or its subcontractors who might work on the contract have with a health insurance carrier or a health managed care organization (including a standalone Medicaid MCO or Medicare Advantage Plan) licensed by the Maryland Insurance Administration (MIA) or a Maryland health care system. During the course of performing work under this contract, the Contractor shall notify MHCC if it takes on new work with a health insurance carrier or health managed care organization licensed by the MIA or a Maryland hospital or health care system.

3) Proposed Work Plan

The Offeror shall give a definitive description of the proposed plan to meet the requirements of the RFP, i.e., a Work Plan. The Work Plan shall include the specific methodology, techniques, and number of staff, if applicable, to be used by the Offeror in providing the required goods and services as outlined in RFP Section 3, Contractor Requirements: Scope of Work. Project deadlines considered contract deliverables must be recognized in the Work Plan.

4.3 Volume II - Financial Proposal

The Financial Proposal shall contain all price information in the format specified in Attachment B.

The Offeror shall complete the Financial Proposal Form only as provided in the Financial Proposal Instructions and the Financial Proposal Form itself. Do not amend, alter, or leave blank any items on the Financial Proposal Form or include additional clarifying or contingent language on or attached to the Financial Proposal Form. Failure to adhere to any of these instructions may result in the Proposal being determined to be not reasonably susceptible of being selected for award and rejected by the Commission.

SECTION 5 - EVALUATION AND SELECTION PROCESS

5.1 Evaluation Committee

Evaluation of Proposals will be performed in accordance with COMAR 21.05.03 by a committee established for that purpose and based on the evaluation criteria set forth below. The Evaluation Committee will review Proposals, participate in Offeror oral presentations and discussions, and provide input to the Procurement Officer. The Commission reserves the right to utilize the services of individuals outside of the established Evaluation Committee for advice and assistance, as deemed appropriate.

During the evaluation process, the Procurement Officer may determine at any time that a particular Offeror is not susceptible for award.

5.2 Technical Proposal Evaluation Criteria

The evaluation criteria set forth below are arranged in descending order of importance.

(Therefore, 1 is more important than 2 and 2 is more important than 3). Within each criteria, the subcriteria are also arranged in descending order of importance. (In other words, 2.A is more important than 2.B; and 3.A, is more important than 3.B., and 3.B. is more important than 3.C., etc.) In addition, it would be improper to assume that 2.A. is either less important or more important than 3.A., 3.B., etc. A contractor can only conclude that criteria 3 as a whole is less important than criteria 2 as a whole.

1. Experience and Qualifications of Proposed Staff

● Each proposed staff person shall have a minimum of 5 years of experience in health benefit actuarial consulting

2. Contractor Qualifications

● Sufficient proof of Contractor qualifications to meet proposal requirements and timeframes

● Demonstrated commitment to providing quality services based on work performed for clients on related projects

3. Proposed Work Plan

● Ability of work plan to successfully meet the requirements and timeframes of this solicitation

● Approach to overall and task-specific management

4. Statement of Problem

5. Disclosure of Conflicts or Potential Conflicts

5.3 Financial Proposal Evaluation Criteria

All Qualified Offerors (see Section 6.5.2.D) will be ranked from the lowest (most advantageous) to the highest (least advantageous) price based on the Total Proposal Price within the stated guidelines set forth in this RFP and as submitted on Attachment B - Financial Proposal Form.

5.4 Reciprocal Preference

5.4.1 Although Maryland law does not authorize procuring agencies to favor resident Offerors in awarding procurement contracts, many other states do grant their resident businesses preferences over Maryland contractors. COMAR 21.05.01.04 permits procuring agencies to apply a reciprocal preference under the following conditions:

a. The Maryland resident business is a responsible Offeror;

b. The most advantageous Proposal is from a responsible Offeror whose principal office, or principal base of operations is in another state;

c. The other state gives a preference to its resident businesses through law, policy, or practice; and

d. The preference does not conflict with a federal law or grant affecting the procurement Contract.

The preference given shall be identical to the preference that the other state, through law, policy, or practice gives to its resident businesses.

5.5 Selection Procedures

5.5.1 General

A. The Contract will be awarded in accordance with the Competitive Sealed Proposals (CSP) method found at COMAR 21.05.03. The CSP method allows for the conducting of discussions and the revision of Proposals during these discussions. Therefore, the State may conduct discussions with all Offerors that have submitted Proposals that are determined to be reasonably susceptible of being selected for contract award or potentially so. However, the State reserves the right to make an award without holding discussions.

B. With or without discussions, the State may determine the Offeror to be not responsible or the Offeror’s Proposal to be not reasonably susceptible of being selected for award at any time after the initial closing date for receipt of Proposals and prior to Contract award.

5.5.2 Selection Process

A. Technical Proposals are evaluated for technical merit and ranked. During this review, oral presentations and discussions may be held. The purpose of such discussions will be to assure a full understanding of the State’s requirements and the Offeror’s ability to perform the services, as well as to facilitate arrival at a Contract that is most advantageous to the State. Offerors will be contacted by the State as soon as any discussions are scheduled.

B. Offerors must confirm in writing any substantive oral clarifications of, or changes in, their Technical Proposals made in the course of discussions. Any such written clarifications or changes then become part of the Offeror’s Technical Proposal. Technical Proposals are given a final review and ranked.

C. The Financial Proposal of each Qualified Offeror (a responsible Offeror determined to have submitted an acceptable Proposal) will be evaluated and ranked separately from the Technical evaluation. After a review of the Financial Proposals of Qualified Offerors, the Evaluation Committee or Procurement Officer may again conduct discussions to further evaluate the Offeror’s entire Proposal.

D. When in the best interest of the State, the Procurement Officer may permit Qualified Offerors to revise their initial Proposals and submit, in writing, Best and Final Offers (BAFOs). The State may make an award without issuing a request for a BAFO.

5.5.3 Award Determination

Upon completion of the Technical Proposal and Financial Proposal evaluations and rankings, each Offeror will receive an overall ranking. The Procurement Officer will recommend award of the Contract to the responsible Offeror that submitted the Proposal determined to be the most advantageous to the State. In making this most advantageous Proposal determination, technical factors will receive greater weight than financial factors.

Attachment A – Contract

MHCC 00-000

Title

THIS CONTRACT (the “Contract”) is made this day of , 20 by and between (the “Contractor”) and the STATE OF MARYLAND, acting through the MARYLAND HEALTH CARE COMMISSION (“MHCC” or the “Commission”).

In consideration of the promises and the covenants herein contained, the adequacy and sufficiency of which are hereby acknowledged by the parties, the parties agree as follows:

1. Definitions

In this Contract, the following words have the meanings indicated:

1.1 “COMAR” means Code of Maryland Regulations.

1.2 “Contractor” means the entity first named above whose principal business address is

(Contractor’s primary address) and whose principal office in Maryland is (Contractor’s local address), whose Federal Employer Identification Number or Social Security Number is (Contractor’s FEIN), and whose eMaryland Marketplace Advantage vendor ID number is (eMMA Number).

1.3 “Financial Proposal” means the Contractor’s [pick one: Financial Proposal or Best and Final Offer (BAFO)] dated (Financial Proposal date or BAFO date).

1.4 “RFP” means the Request for Proposals for <<solicitationTitle>>, Solicitation # MHCC 24-003 and any amendments, addenda, and attachments thereto issued in writing by the State.

1.5 “State” means the State of Maryland.

1.6 “Technical Proposal” means the Contractor’s Technical Proposal dated. (Technical Proposal date), as modified and supplemented by the Contractor’s responses to requests, clarifications and requests for cure, and by any Best and Final Offer.

2. Scope of Contract

2.1 The Contractor shall perform in accordance with this Contract and Exhibits A-D, which are listed below and incorporated herein by reference. If there is any conflict between this Contract and the Exhibits, the terms of the Contract shall control. If there is any conflict among the Exhibits, the following order of precedence shall determine the prevailing provision:

Exhibit A – The RFP Exhibit B – The Contract Affidavit, executed by the Contractor and dated

Exhibit C – The Technical Proposal

Exhibit D – The Financial Proposal

2.2 The Procurement Officer may, at any time, by written order, make unilateral changes in the work within the general scope of the Contract. No other order, statement, or conduct of the Procurement Officer or any other person shall be treated as a change or entitle the Contractor to an equitable adjustment under this section. Except as otherwise provided in this Contract, if any change under this section causes an increase or decrease in the Contractor’s cost of, or the time required for, the performance of any part of the work, whether or not changed by the order, an equitable adjustment in the Contract price shall be made and the Contract modified in writing accordingly.