Q&A Responses - Other Interested Party.xlsx
XLSX spreadsheet 19 KB Posted
- Attached to
- Indiana Medicaid Managed Care Organizations
- Solicitation number
- RFP 27-88343
- Issued by
- Marion County, Indiana
About this file
This file contains Question & Answer Responses from the Indiana Family and Social Services Administration's Office of Medicaid Policy and Planning regarding RFP 27-88343 for statewide Medicaid Managed Care Organization services across four programs: Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging. The RFP solicits proposals from managed care organizations to serve approximately 1.5 million Hoosiers across these programs. Written questions were due September 11, 2026, with State responses provided by October 2, 2026, followed by a second round of questions closing October 9, 2026, with responses by October 23, 2026. Proposals are due November 6, 2026, with a pre-proposal conference held on September 10, 2026. The contract term is four years with two optional one-year renewals, for a potential total of six years. Respondents must demonstrate current MCO service in at least one state and at least five years of prior MCO experience, maintain Indiana-licensed health maintenance organization status with NCQA accreditation, and establish administrative offices within five miles of the Indiana Government Center in Indianapolis.
The Q&A document addresses 19 substantive inquiries from prospective bidders covering critical operational topics including work requirement navigation for Healthy Indiana Plan members, care coordination delegation to community-based organizations, non-emergency medical transportation (NEMT) eligibility and coverage parameters, subcontractor requirements, behavioral health carve-in transitions, Indiana Veteran Owned Small Business (IVOSB) participation calculations, and cloud infrastructure authorization standards. State responses clarify that MCOs retain sole responsibility for care coordination and quality outcomes; NEMT is available only for transportation to and from IHCP-covered services; administrative expenses qualify for IVOSB Valuable Scope Contribution consideration but not covered benefit expenditures; and second-tier IVOSB participation does not qualify for credit toward IVOSB goals. The total estimated base capitation across all four programs exceeds $4.9 billion for the initial rating period, with composite PMPM rates varying by program and population, subject to a pay-for-outcomes withholding of 1.85-2.25 percent annually from 2029-2034. Respondents must achieve minimum Risk Based Capital ratios of 300 percent per NAIC standards and obtain fidelity bond, professional liability insurance, and commercial reinsurance with defined parameters.
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Question & Inquiry Form
| Question and Answer Template | ||||||
| Other Interested Party | ||||||
| RFP 27-88343 | ||||||
| Please submit your questions in the form below (blue shaded area) by the dates specified in RFP Section 1.24 | ||||||
| Click the dropdown in the RFP Document Column to select topic. | ||||||
| No. | RFP Document | Section Number | Page | Topic | Question | Answer |
| 1 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 13.1.2 | 301 | Work Requirements- Member Navigation | Section 13.1.2 recognizes multiple ways for members to satisfy HIP work requirements, including employment, education, participation in work programs, and community volunteering. Does the State expect the Contractor to develop a member-level navigation or triage process that helps members identify the type of workforce, education, training, or community resource appropriate to their circumstances, or would providing members with general resource information satisfy the Contractor’s responsibilities? If a navigation or triage process is expected, should Respondents describe that methodology in the Technical Proposal, and if so, in which section? | The State plans to allow MCOs flexibility to be creative and innovative in assisting members meet work requirements. The current language in the Statement of Work for Healthy Indiana Plan allows that flexibility. |
| 2 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 13.1.2 | 301 | Work Requirements - Sttaus File and Performance | Section 13.1.2 states that FSSA will provide the Contractor with a supplemental file identifying work requirement status for members enrolled in the Contractor’s health plan. Will the Contractor be required to take or report specific actions based on this file, such as member contact, assistance provided, referral activity, documentation support, or re-enrollment outcomes following disenrollment? Or is the supplemental file intended primarily to support internal member outreach and assistance, with any reporting requirements to be defined separately in the MCO Reporting Manual? | Please see response for Question #1. |
| 3 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 2.3.4; 13.1.2 | 30; 301 | Workforce Administrator - Referral Follow-up | Section 2.3.4 requires the Workforce Administrator to administer assistance planning assessments, develop member assistance plans, and conduct assistance planning outreach, and Section 13.1.2 requires the Contractor to support members in meeting work requirements. When a Contractor refers a member to a workforce, education, training, or community organization, does FSSA expect the Contractor to establish a process for receiving information back regarding whether the member connected, enrolled, participated, or completed an activity? Or is the Contractor's responsibility satisfied once the member has been appropriately assisted and referred, with work-requirement compliance subsequently determined through FSSA/DFR processes? If follow-up or information exchange is expected, should Respondents describe that process in the Technical Proposal? | Please see response for Question #1. |
| 4 | Att K1 - Exhibit 1 Hoosier Healthwise - Statement of Work | 2.8 | 51 | Subcontractors | Section 2.8 defines a subcontract to include "any entity that performs delegated activities related to the Contract," states that the State "encourages the Contractor to subcontract with entities located in the State of Indiana," and conditions FSSA approval on the prospective subcontractor's demonstrated ability and "experience in providing such service and/or care." Section 4.14 provides that Care Coordinators "may include licensed and non-licensed personnel" and applies training requirements to the Contractor's "employed and contracted staff." Will the State confirm that a Contractor may, with FSSA approval under Section 2.8, delegate care coordination functions to a qualified Indiana community-based organization including a community-based IDD, behavioral health, or disability services provider with documented care coordination experience and that eligibility to receive such a delegation is not limited to the five case management entities awarded contracts through the FSSA Bureau of Developmental Disabilities Services? | As the State contracted entity, the MCOs are soley responsible for ensuring care coordination is provided to all eligible members as outlined in the Statement of Work. |
| 5 | Att K3 - Exhibit 1 Hoosier Care Connect - Statement of Work | 4.4.5 | 131 | Subcontractors | Community-based organizations that already serve Medicaid members with intellectual and developmental disabilities in their home regions offer capabilities the SOW expressly requires: an existing trusted relationship with the member and family that shortens time to engagement; local knowledge of housing, employment, transportation and natural supports; in-person and in-home capacity, including the home-visit capability required at Section 4.4.5 and the in-person engagement expectation for members who cannot be reached telephonically; alignment with the person-centered frameworks the State names at Section 4.3 (Person-Centered Thinking, Charting the LifeCourse); direct access to community health worker and peer support staff recruitable in markets where licensed clinicians are not; cultural, linguistic and geographic compatibility of the assigned coordinator as contemplated at Section 4.14.1; and a reduction in the number of separate coordinators assigned to the same family, which is a persistent driver of member and family grievances.Will the State affirm that delegation of care coordination to such organizations is permissible under Section 2.8, and (b) will Respondents that propose contracted community-based care coordination arrangements including risk-sharing or value-based arrangements with those organizations receive consideration under the Management Assessment/Quality criteria in RFP Section 3.2.2? | Please see response for Question #4. |
| 6 | Att K3 - Exhibit 1 Hoosier Care Connect - Statement of Work | 7 | 246 | Quality Improvement Goals | If community-based organizations are expected to contribute to quality outcomes, care coordination, social drivers of health, and population health objectives, what mechanisms will exist to ensure those organizations participate in governance, receive actionable data, and share in the financial incentives tied to those outcomes? | As the state contracted entity, the MCOs are soley responsible for meeing the quality improvement requirements in the Statement of Work. |
| 7 | Att A - IVOSB Commitment Form | 2.1 | 2 | IVOSB Commitment - Administrative Bid Amount Calculation | Attachment A states that the IVOSB commitment is calculated as a percentage of the Administrative Bid Amount, a non-medical, administrative cost basis. Please confirm that covered benefit expenditures submitted to the State via claim encounters, including the covered benefit portion of NEMT expenses, may not be counted toward the IVOSB commitment. Allowing covered benefit expenditures to satisfy a commitment calculated solely from administrative expense would create an inconsistent calculation and a competitive advantage for Respondents whose covered-benefit vendors happen to qualify as IVOSBs. Can you confirm that only administrative expenses that qualify as Valuable Scope Contribution, and not covered benefit expenditures, may be applied toward the IVOSB commitment in the RFP response? | Administrative expenses that are not direct member services qualify for IVOSB VSC consideration. NEMT is regarded as a direct member service. Respondents should submit any other clarifying questions regarding VSC in the second round of Q&A |
| 8 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 3.15; 6.2.14 | 90-91; 199 | HIP NEMT eligibility and rate treatment | Does Section 3.15, read with Section 6.2.14 and Attachment O2, make standard NEMT available to all enrolled Healthy Indiana Plan members, including HIP populations for whom ordinary NEMT has not historically been included? If yes, please confirm how capitation rates will recognize the additional utilization. Please also define “no other means of transportation available,” including how contractors should evaluate affordability or insufficient travel resources, vehicle availability, public-transit availability and practicality, informal supports, accessibility, safety, and timeliness. | Health Indiana Plan members will be eligible for state plan benefits, which includes NEMT. As with any Medicaid covered service, the entity providing the service must be an IHCP attested provider and be in-network with the MCO. Medicaid reimbursement is not allowed for providers who are not IHCP attested. |
"No other means of transportation" means the member has no other way to their appointment with an IHCP Medicaid attested provider.
| 9 | Att O3 - Exhibit 3 Hoosier Care Connect - Program Description and Covered Benefits | Transportation – Non-emergency medical | 18 | Hoosier Care Connect trip and distance limits | Does the omission of the prior twenty (20) one-way-trip limit, under-fifty-mile limitation, and related authorization threshold mean those restrictions are removed for the new contract? If any trip, mileage, distance, or authorization limitation remains, please identify the controlling provision and describe how long-distance trips and requests exceeding any standard limit must be administered. | Medicaid reimburses NEMT when transportation provided is the least expensive type of transportation that meets the medical needs of the member. NEMT reimbursement is allowed when a member is transported to and/or from an IHCP covered service. While the trip limits and mileage limits are not stated, the MCO must ensure all trips meet medical necessity. |
| 10 | Att K1 - Exhibit 1 Hoosier Healthwise - Statement of Work | 3.5.5; 3.15 | 87-88; 92-93 | Behavioral-health carve-in and waiver transportation | For MRO, AMHH, BPHC, and CCBHC services that are now carved into managed care, when is transportation to or in support of those services the contractor’s NEMT responsibility, and when, if ever, may transportation remain within a 1915(i) or 1915(c) service plan? Please define the controlling purpose-of-trip and funding hierarchy, including transportation integral to adult day, habilitation, or community-participation services; explain how duplicate authorization or reimbursement must be prevented; and confirm whether capitation rates recognize any transportation utilization shifted to the contractor. Attachment O4, page 16, separately lists transportation as a PathWays 1915(c) waiver service. | Transportation under NEMT is only allowable when a member is being transported to and/or from an IHCP covered service. Transportation to and/or from IHCP covered service is a non-allowable under 1915(i) and 1915(c) waivers. |
| 11 | Att K1 - Exhibit 1 Hoosier Healthwise - Statement of Work | 3.5.5 | 87-88 | Fee-for-service provider transition | What transition, technical-assistance, and readiness requirements will FSSA establish for MRO, AMHH, BPHC, CCBHC, and other affected providers that have historically billed Medicaid fee-for-service and must operate under MCO-managed services? Please address contracting and credentialing, prior authorization, electronic claims and encounters, remittance and payment, coordination and reporting, denial and appeal workflows, testing, training, and continuity protections during implementation. | The transition plan is in development. There is nothing to share at this time. |
| 12 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 3.15; 3.22; 7.6; 13.1.2 | 90; 99-100; 241; 301-303 | Transportation supporting HIP work requirements | Is transportation to qualifying employment, education, work-program, or volunteer activities a covered Healthy Indiana Plan benefit? If not, may a contractor offer a targeted workforce-access transportation benefit as an FSSA-approved enhanced benefit using time-limited transit passes, mileage or fuel assistance, or limited rideshare or transportation-provider trips? Please confirm whether the $300 aggregate annual enhanced-benefit and incentive limit applies to such transportation and whether FSSA may approve an exception. | Transportation paid for under Medicaid is called Non-Emergent Medical Transportation (NEMT). Reimbursement for NEMT is only allowed when a member is going to and/or from an IHCP covered service. |
| 13 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 6.2.10 | 196-199 | Indian Health Care Provider access and NEMT | Which Section 5006(d) Indian Health Care Providers does FSSA recognize as serving Indiana Medicaid members, including out-of-state facilities? For eligible American Indian and Alaska Native members traveling to those providers, please clarify how protected provider access interacts with NEMT destination review, prior authorization, distance standards, network requirements, and payment for long-distance trips. | Indiana does not have federally operated Indian Health Service (IHS) hospitals within the state. |
| 14 | Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work | 3.15.1; 5.3.1 | 91; 152-153 | NEMT call-center coverage and service standards | What functions must the required 24/7/365 transportation call center perform outside normal scheduling hours, and must a live agent be available at all times? Please distinguish routine advance reservations, same-day urgent requests, hospital discharge, will-call return activation, trip-status inquiries, complaints, and service recovery. Please also identify the answer-time, abandonment, pickup, response, escalation, language-access, and other performance standards that apply to NEMT call centers under Section 5.3.1. | All call centers are required to meet with requirements in the statement of work under section 5.3 and 6.11. NEMT requires access 24/7/365 to address pick ups for hospital discharge and trips that operate outside normal call center hours. |
| 15 | Att N - Exhibit 2 Contract Compliance and Pay for Outcomes | A.14-A.15; Table 1 | 10; 17 | NEMT readiness, reporting, and remedies | Will FSSA publish NEMT-specific readiness-review scenarios, operating and reporting specifications, performance measures, remedies, or liquidated damages before award? If not, please identify which requirements in Attachment D, Attachment N, the MCO Reporting Manual, and the Policies and Procedures Manual will apply specifically to the contractor’s transportation subcontractor and NEMT operations, including the 24/7/365 call center, web scheduling, facility line, network adequacy, trip fulfillment, complaints, and encounter or claims reporting. | Readiness reviews are with the State contracted MCO. It will be the responsibility of the MCO to share State readiness requirements with subcontractors. |
| 16 | Att M - Infrastructure Overview | IOT RAMP; 1.1.4 | 1-5 | Cloud authorization and subcontractor scope | Attachment M references the IOT Risk and Authorization Management Program Policy for Cloud Offerings but does not specify a FedRAMP, GovRAMP, StateRAMP, or equivalent authorization level. Please identify the required authorization framework, impact or security level, and evidence required at proposal submission, readiness review, and go-live. Please also confirm whether the requirement applies to subcontractor systems supporting NEMT or other Medicaid functions, including SaaS, PaaS, IaaS, hosting, call-center, routing, member portal, mobile, analytics, and data-integration services, and whether reliance on an authorized underlying cloud provider is sufficient. | Please use the following URL for Statewide IT policies and Standard guidance - https://www.in.gov/iot/policies-procedures-and-standards/, specifically, Indiana RAMP Policy for Cloud Offerings. |
| 17 | Att A - IVOSB Commitment Form | N/A | N/A | Valuable Scope Contribution / IVOSB Participation | For purposes of satisfying the State’s IVOSB participation goals and Valuable Scope Contribution requirements under RFP 27-88343, may a certified IVOSB provide healthcare workforce-related services such as provider recruitment, credentialing, onboarding, scheduling, workforce administration, retention support, member engagement, and related clinical staffing operations as a qualifying scope of work? If so, are there any minimum requirements regarding the nature or percentage of that work for it to be considered a Valuable Scope Contribution? | Administrative expenses that are not direct member services qualify for IVOSB VSC consideration. |
| 18 | Att A - IVOSB Commitment Form | N/A | N/A | Second-Tier IVOSB Participation | If an MCO respondent contracts with a healthcare subcontractor that, in turn, subcontracts a defined portion of its scope to an Indiana-certified IVOSB, may that second-tier IVOSB participation be counted toward the respondent’s applicable IVOSB participation goal? Or must the certified IVOSB have a direct first-tier subcontract with the MCO respondent in order for its participation to receive credit? | Second tier IVOSB participation does not qualify for Respondent IVOSB VSC |
| 19 | Att Q - Exhibit 5 Contract Definitions | N/A | N/A | Calculation of IVOSB Participation Credit | When determining the value of IVOSB participation under RFP 27-88343, is credit calculated based on the total dollar value paid to the certified IVOSB for its subcontracted scope, or only on certain qualifying labor or service components? Please clarify how respondents should calculate and document the percentage of IVOSB participation included in their proposal. | IVOSB Participation is calculated based on the percentage of IVOSB subcontracted work as part of the $900,500,000.00 administrative bid amount. Proposed IVOSB subcontractors must provide a Valuable Scope Contribution directly related to the requirements of this solicitation and consistent with the industry areas for which the subcontractor is certified. Participation must represent a value‑added contribution to the project. Activities that do not directly support the scope of work or that rely solely on a respondent’s corporate veteran owned strategy are not sufficient to qualify as IVOSB contribution for purpose of evaluation. |
| Att A - IVOSB Commitment Form |
| Att B - Sample Contract |
| Att B1 - IOT - IaaS |
| Att B2 - IOT - PaaS |
| Att B3 - IOT - SaaS |
| Att C - Bidders' Library |
| Att D - Readiness Review |
| Att E - Business Proposal |
| Att F1 - Technical Proposal Response Template |
| Att F2 - Outcomes Measures Response Template |
| Att H1 - Reference Form |
| Att H2 - Complete Reference Listing Response Template |
| Att I - Pre-Proposal Network Opportunities Form |
| Att J - Attestation Form |
| Att K1 - Exhibit 1 Hoosier Healthwise - Statement of Work |
| Att K2 - Exhibit 1 Healthy Indiana Plan - Statement of Work |
| Att K3 - Exhibit 1 Hoosier Care Connect - Statement of Work |
| Att K4 - Exhibit 1 Indiana PathWays for Aging - Statement of Work |
| Att L - Artifical Intelligence - Technical Proposal Questions |
| Att M - Infrastructure Overview |
| Att N - Exhibit 2 Contract Compliance and Pay for Outcomes |
| Att O1 - Exhibit 3 Hoosier Healthwise - Program Description and Covered Benefits |
| Att O2 - Exhibit 3 Healthy Indiana Plan - Program Description and Covered Benefits |
| Att O3 - Exhibit 3 Hoosier Care Connect - Program Description and Covered Benefits |
| Att O4 - Exhibit 3 Indiana PathWays for Aging - Program Description and Covered Benefits |
| Att P1 - Exhibit 4 Hoosier Healthwise - Responsibilities of the State |
| Att P2 - Exhibit 4 Healthy Indiana Plan - Responsibilities of the State |
| Att P3 - Exhibit 4 Hoosier Care Connect - Responsibilities of the State |
| Att P4 - Exhibit 4 Indiana PathWays for Aging - Responsibilities of the State |
| Att Q - Exhibit 5 Contract Definitions |
| Att R1 - Exhibit 6 Hoosier Healthwise - Capitation Rates |
| Att R2 - Exhibit 6 Healthy Indiana Plan - Capitation Rates |
| Att R3 - Exhibit 6 Hoosier Care Connect - Capitation Rates |
| Att R4 - Exhibit 6 Indiana PathWays for Aging - Capitation Rates |
| Att S - Capitation Rate and Certifications and Rate Exhibits |
| RFP Instructions |
https://www.in.gov/iot/policies-procedures-and-standards/
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