QLV27007040 Solicitation Pre-Bid Conference Slides.pptx
PPTX presentation 1 MB Posted
- Solicitation number
- QLV27007040
- Issued by
- Providence County, Rhode Island
About this file
This file contains pre-bid conference slides for the Rhode Island Executive Office of Health and Human Services' solicitation for a Qualified List of Vendors (QLV) to administer the Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Program. The FIDE-SNP Program serves approximately 37,060 full-benefit dual-eligible members age 21 and older who are entitled to Medicare Parts A and B and eligible for full Medicaid benefits. The scope encompasses plan management, member services, care coordination, and integration of medical and behavioral health services across nursing home, home and community-based services, developmentally disabled, severe and persistent mental illness, and community well populations. A non-mandatory pre-bid conference was held on October 15, 2026, and vendor questions were due October 16, 2026. Proposals are due November 4, 2026. The initial contract term runs January 1, 2028 through December 31, 2028, with renewal options for up to five additional 12-month periods at the State's discretion based on performance and fund availability. The State reserves the right to award one to three bidders.
Minimum qualifications require federal MCO status, Rhode Island HMO licensure or commitment to obtain it within 60 days of contract execution, at least three consecutive years managing medical, behavioral, and long-term services and support services with a minimum of 50,000 combined Medicaid, Medicare, or Medicaid-like members, current NCQA or URAC accreditation, and CMS approval to execute an integrated D-SNP contract for plan year 2028. Bidders must maintain a Rhode Island location within three months of award within a 25-mile radius of Cranston, Rhode Island. A 0.33% contract administrative fee will be withheld from invoices. Comprehensive insurance requirements include general liability ($1 million per occurrence/$2 million aggregate), workers' compensation, automobile liability ($1 million), professional liability ($2 million per occurrence/$3 million aggregate), cyber/privacy liability ($20 million per occurrence/aggregate), and physical abuse and molestation liability ($1 million per occurrence). Vendors must meet a minimum 10% dollar-value participation requirement by certified minority and women-owned businesses. Technical proposals are scored out of 100 points with a passing threshold of 60 points, and up to 6 ISBE bonus points are available. All submissions must be electronic through Ocean State Procures.
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Fully Integrated Dual Special Needs Plan (FIDE-SNP) Program Solicitation: QLV27007040 October 15, 2026 10:00am Qualified List of Vendors (QLV) Pre-Bid Conference
RHODE ISLAND
Conference Purpose
The information presented today is a general overview and may not cover all requirements in each section of the Solicitation.
It is essential for interested parties to carefully review all posted Solicitation materials, including any addendums (e.g., the State Medicaid Agency Contract).
Today's presentation will not provide exhaustive details or all necessary information for a Bidder to be successful.
All parties involved in the procurement have equal access to the information available on the RIDOP website and the EOHHS Procurement Library reference materials.
Questions will not be answered during this conference. If additional clarifications are needed, interested parties should ask questions during the Q&A period through RIDOP.
Interested parties, including any subcontractors, shall not communicate with EOHHS staff or contractors involved in the Solicitation’s development.
Background
IN THIS SECTION
EOHHS Overview FIDE-SNP Program Model Program Goals Membership: Eligibility & Distribution
BACKGROUND
Rhode Island EOHHS Sources: https://eohhs.ri.gov/about-eohhs; https://www.rilegislature.gov/Special/comdoc/Senate%20Finance%205212020/FY26%20EOHHS%20Senate%20Finance%20Slide%20Deck%20rev.pdf
EOHHS AT A GLANCE
Single state agency (SSA) responsible for administering the Medicaid program Oversees management of Department of Health (DOH), Human Services (DHS), Children, Youth and Families (DCYF), and Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) Administers Medicaid program, inclusive of federal funds, general revenues, and restricted receipts
$4.2B Medicaid program administered by EOHHS 290,000+ Rhode Islanders enrolled in Medicaid managed care
1 in 4 Rhode Islanders of all ages covered by Medicaid
Successful Bidders may also offer a Coordination Only D-SNP (CO D-SNP) for partial-benefit dually eligible individuals only.
FBDE may not be enrolled in a Bidder’s CO D-SNP.
Medicaid managed care plan enrollment requires enrollment in the same organization’s Medicare D-SNP.
Members that do not select a Bidder’s FIDE-SNP for Medicare coverage will receive their Medicaid benefits through fee-for-service (FFS).
Member selects Bidder’s FIDE-SNP for Medicare coverage Member enrolled into aligned Medicaid managed care plan Single integrated Medicare + Medicaid delivery system
ADDITIONAL REQUIREMENTS
COVERED BENEFITS
Primary care Acute care Behavioral health Durable medical equipment Long-term services and supports (LTSS)
FIDE-SNP Program Model
EXCLUSIVELY ALIGNED ENROLLMENT
Healthier Communities Improve population health outcomes and advance equity by addressing social drivers of health.
Value & Affordability Control costs through value-based care and budgets that stay predictable.
Better Member Experience Help members make informed choices and navigate care in their preferred setting.
Coordinated Care Integrate care across Medicare and Medicaid to reduce duplication and fragmentation.
Empowered Providers Reduce provider burden and equip the network with the tools, data, and support to deliver integrated care.
Accountability Strengthen reporting and tie payments to person-centered, efficient care and member outcomes.
FIDE-SNP Program Goals
MEMBERS ELIGIBLE TO ENROLL IN FIDE-SNP PROGRAM:
Age twenty-one (21) or older;
Entitled to or are enrolled in Medicare Part A;
Entitled to or enrolled in Medicare Part B; and Eligible for full Medicaid benefits under the Rhode Island Medicaid State Plan.
BACKGROUND
Membership: Eligibility 1 FIDE-SNP plan Neighborhood Health Plan of Rhode Island
Up to 3 qualified plans Competitive, multi-plan program
TODAY
THROUGH THIS SOLICITATION
All FBDE beneficiaries will be offered choice to enroll with successful Bidders selected by the State
| Population | Fee-for-Service | NHPRI FIDE-SNP | PACE | Total |
| LTSS | ||||
| Nursing Home | 4,208 | 483 | - | 4,691 |
| HCBS Waiver | 5,353 | 2,577 | - | 7,930 |
| Developmentally Delayed (DD) | 1,520 | 1,162 | - | 2,682 |
| Non-LTSS | ||||
| Severe and Persistent Mental Illness (SPMI) | 946 | 1,228 | - | 2,174 |
| Community Well | 13,829 | 5,337 | - | 19,166 |
| FBDE Total | 25,856 | 10,787 | 416 | 37,060 |
FULL BENEFIT DUAL ELIGIBLE ENROLLMENT DISTRIBUTION AS OF AUGUST 2026 (BY POPULATION)
BACKGROUND
Membership: Distribution of Members
FFS TODAY
25,856 70% of 37,060 FBDE members
Solicitation Overview
IN THIS SECTION
General Solicitation Information Minimum Qualifications Scope of Work & Bidder Responsibilities
EOHHS will qualify at least one and no more than three MCOs to serve FBDE members statewide.
QUALIFIED LIST OF VENDORS
1-3 qualified bidders will be selected
The State seeks qualified MCOs for Medicaid-covered services.
Contracts are risk-based under the Rhode Island FIDE-SNP Program.
The procurement establishes a Qualified List of Vendors – there is no cost proposal.
Selected entities deliver integrated benefits under a SMAC.
Services will be statewide.
CONTRACT STRUCTURE AND FINANCIAL MODEL
TERM
Jan 1 – Dec 31, 2028 Initial contract term is one year based on CMS Medicare
RENEWALS
5 renewals Up to 5 (five) additional twelve (12) month renewal periods
PAYMENT
PMPM capitation Payments will be statewide, capitated, risk-bearing
RATES
Actuarially sound Risk-adjusted rates set by EOHHS and state actuarial vendor Rates are not subject to negotiation or dispute resolution. Contractors must meet applicable risk-based capital, reserve, and solvency requirements.
SOLICITATION OVERVIEW
General Solicitation Information
Managed care organization Meet the current federal definition of an MCO under 42 C.F.R. § 438.2.
HMO licensure Operate as an HMO licensed by the RI Department of Business Regulation (DBR); or receive RI HMO licensure or approval no later than sixty (60) days after SMAC execution. Bidders not currently licensed in Rhode Island must provide a detailed licensure timeline as outlined in this Solicitation.
Non-exclusion status Not be an excluded individual or entity under 42 C.F.R. § 438.808(b).
Capacity to perform Have the capacity and willingness to perform all SMAC functions, consistent with Medicaid managed care requirements and Medicare requirements under 42 C.F.R. Parts 422 and 423.
Experience and scale At least three (3) consecutive years managing medical, behavioral, and LTSS services covered by Medicaid and/or Medicare; and serve a minimum combined total of fifty thousand (50,000) Medicaid, Medicare, or Medicaid-like members in one (1) or more U.S. states or territories.
Principal place of business Have its principal place of business located within the United States.
Accreditation Be currently accredited by a nationally recognized agency, such as NCQA and/or URAC, consistent with 42 C.F.R. § 438.224.
Formatting compliance Be in compliance with all formatting requirements as outlined in this Solicitation.
THE SOLICITATION SHOULD BE READ TOGETHER WITH:
State Medicaid Agency Contract (SMAC) Special Agency Requirements Attachments & Addenda FIDE-SNP Manual EOHHS General Terms and Conditions
Bidders must offer all required services. Your proposal will become part of the contractual framework by reference.
Scope of Work & Bidder Responsibilities
Evaluation Process & Timeline
IN THIS SECTION
OSP submission process Proposal organization Proposal scoring criteria Technical scoring and evaluation Timeline Readiness review
EVALUATION PROCESS AND TIMELINE
OSP Submission Process Register in OSP System All bidders must hold an active Ocean State Procures (OSP) account.
Find the Solicitation Access the OSP Bid Board via https://ridop.ri.gov.
Download Bid Documents Log in to download the full solicitation package, forms, and attachments.
Monitor OSP for addenda — posted to the solicitation record only.
Submit Questions Use the OSP Q&A function within the posted question window.
All questions go through RIDOP. Responses are posted for all bidders.
Submit the Bid Response Upload and submit the complete response online in OSP before the closing date and time.
Late or emailed submissions are not accepted.
REMINDER
Only registered OSP vendors may submit a bid. Bidders should allow time for upload — OSP closes submissions automatically at the deadline. Review the OSP Vendor Reference Guide and Solicitation Response Checklist in the Vendor Training Center before submitting a proposal.
https://ridop.ri.gov/vendor-resources/all-solicitations
Proposal Organization
No page limit Executive Summary 5-page limit Business Proposal 5-page limit Technical Proposal 85-page limit (individual limits per section)
Submit one searchable PDF
Follow the prescribed order and numbering Include a linked table of contents Use compliant font size, margins, headers, pagination Follow the required naming convention Mark information confidential per OSP requirements
KEY FORMATTING REQUIREMENTS
Content beyond an applicable page limit will not be evaluated Attachments, including graphics, flowcharts, diagrams, tables, sample materials, and any other items included as attachments, do not count toward the maximum page limit.
Scored pass/fail
Business Proposal Scored pass/fail (requirements must be satisfied to have Technical Proposal scored)
Executive Summary Informational only (not scored) but must be included to meet proposal requirements
Technical Proposal Point value (60 point minimum threshold)
Proposal Scoring Criteria Proposals must meet all Minimum Qualifications to be considered for possible award.
Opportunity for Bidder to provide additional insight into their organization.
Essential minimum business elements needed to ensure compliance with contract requirements.
Each question scored on 0-5 scale to determine percentage of available points Bidder will earn.
Technical Proposal Scoring
| Question | Criterion | Points Available |
| 5.1 | Organizational Qualifications and Experience | 20 |
| 5.2 | Covered Services and Proposed Benefits | 15 |
| 5.3 | Population Health and Care Management | 20 |
| 5.4 | Network Provider Access | 10 |
| 5.5 | Member Experience and Engagement | 10 |
| 5.6 | Quality Improvement and Outcomes | 10 |
| 5.7 | Operational Readiness | 15 |
| Total Possible Technical Points | 100 | |
| ISBE Participation | 6 | |
| Total Possible Points | 106 |
Evaluators will assign one (1) score per question Each question scored from zero (0) to five (5) points related to non-compliance or terminations being scored in reverse One hundred (100) points available across all scored items
Overall total point score per Bidder will be calculated by summing the average evaluators’ scores All qualified Bidders may not be selected through this Solicitation EOHHS will select the three highest scores if more than three Bidders meet the passing technical score
EVALUATION PROCESS AND TIMELINE
Technical Proposal Evaluation 100 total
Technical points available 60 points Minimum Technical Proposal score required +6 bonus
Additional ISBE participate points awarded after minimum threshold met BIDDERS WHO MEET MINIMUM QUALIFICATIONS AND BUSINESS PROPOSAL REQUIREMENTS WILL HAVE TECHNICAL PROPOSALS SCORED:
10/2/26 Solicitation Posted
10/15/26 at 10 am Pre-Bidder’s Conference
10/16/26 at 2 pm Q&A Period Ends
By 10/23/26 Q&A Responses Due
11/4/26 Solicitation Closes
Late November/ Early December 2027 Awarded Bidder’s Announced
Anticipated to begin January 2027 Readiness Review Begins
1/1/2028 Operational Go-Live
Anticipated Solicitation Timeline
Complete before go-live
EOHHS may conduct a readiness review before the operational start date.
State timeframe flexibility
EOHHS may amend the review date, delay the operational start date, or continue review activities after the start date.
Schedule from EOHHS
EOHHS will determine and provide the readiness review schedule to Awarded Bidders.
Prove SMAC readiness
Awarded bidders must demonstrate readiness to meet SMAC requirements.
Readiness Review Readiness schedule will be tied to Medicare Advantage calendar.
Failure to meet readiness to satisfaction of EOHHS may lead to award termination.
THANK YOU
Submit all questions through RIDOP during the Q&A period image2.svg image6.svg
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