Response to Offeror Questions document.pdf

RFP #26-08RHT-008 Page 1 of 11

STATE OF SOUTH DAKOTA

OFFICE OF PROCUREMENT MANAGEMENT

523 EAST CAPITOL AVENUE

PIERRE, SOUTH DAKOTA 57501-3182

DSS Rural Health Transformation Primary Accountable Care Transformation Reimbursement Design

Questions and Responses

PROPOSALS ARE DUE NO LATER THAN April 3rd, 2026, AT 5:00 PM CDT

RFP #26-08RHT-008 BUYER: Department of Social Services

POC: Kirsten Blachford Kirsten.Blachford@state.sd.us

Q1:

The RFP indicates in 4.4 that “The offeror may be required to submit a copy of their most recent independently audited financial statements.” Please clarify if a small business could submit financial statements in lieu of an audit.

Can you confirm that we do not need to submit our most recent independently audited financial statements at the time of submission?

When will a copy of audited financial statements be requested?

A1: The State does not currently anticipate requesting this information.

Q2:

RFP Section 1.12 indicates that in the proposal's executive summary, applicants must identify proprietary information and provide justification explaining why the information is to be protected. RFP Section 5.2.2 indicates that the executive summary should be 1-2 pages and should also include the highlights and major features of the proposal, as an indication of any requirements that cannot be met by the offeror. Would it be acceptable to state our claim for protection of certain proprietary information in the Executive Summary and then attach additional justification for our position in an Appendix, where the Appendix is not considered part of the overall two (2) page limit for the Executive Summary?

Can the State confirm that there is no page limit for the Executive Summary (5.2.2) or Detailed Response (5.2.3) section of proposal responses?

A2: The State does not have an enforced page limit for the Detailed Response (5.2.3) or the Executive Summary (5.2.2). The Executive Summary should contain the proprietary information request, but the justification for the proprietary information request can be attached to the proposal as an appendix rather than being part of the Executive Summary.

Q3: Are there any restrictions or contractual provisions that would prevent using offshore resources to deliver the scope of work?

A3: Yes, Offerors should review SDCL 5-18A for detailed provisions related to prohibited foreign contracts.

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Q4: The RFP in 2.14 indicates “The Contractor may not use subcontractors to perform the services described herein without the express prior written consent of the State.” Please clarify if subcontractors are allowed for this RFP and when and how we would need to receive written consent from the state.

A4: The State anticipates a subcontractor may be utilized. Written consent would be provided through the contract process.

Q5: Would the State please share the anticipated level of effort (LOE) for this award?

A5: Offerors can use the Scope of Work to estimate the level of effort. As noted in the RFP the State has some preliminary concepts related to the model.

Q6: Will you conduct in-person oral evaluation of any finalists?

A6: The State does not anticipate conducting in-person oral evaluations of any finalists.

Q7:

What amount of time do you expect the vendor to work onsite?

Section 6.1.5 notes that evaluators will consider several criteria in their review, including “availability to the project locale.” Can the State please provide an estimated, not to exceed number of in-person/onsite meetings that vendors may be required to attend under this scope of work?

Can the State confirm whether the stakeholder meetings referenced in requirement 3.3.6 are expected to be virtual or in-person?

For stakeholder engagement, what are the state’s expectations for in-person vs. remote participation?

A7: The State does not anticipate requiring the vendor to work onsite.

Q8: Could you please provide a list of criteria and associated weights for how you will evaluate the submitted proposals?

A8: Offers are scored on the basis of their response to the Scope of Work as well as on the criteria in 6.1.

Q9: Do you use AI-tools during the review of the responses?

A9: The State does not currently utilize AI tools in the response evaluation process.

Q10: Can you provide an estimated start date for this work?

A10: The State anticipates the work to begin by or on June 1, 2026.

Q11: If the release of the Q&A is delayed for any reason, would DSS consider extending the deadline to allow for at least five business days between receipt of answers to questions and the proposal submission date?

A11: The State’s response to questions was timely released.

Q12: If possible, please provide the comprehensive set of bidder questions and DSS’s answers for this solicitation.

A12: The State will respond to offeror’s inquiries (if required) via e-mail. In addition, all inquiries and the State’s response will be posted on the state’s e-procurement system and the DSS website at http://dss.sd.gov/keyresources/rfp.aspx.

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Q13: Can the State clarify what is meant by "duplication" in the context of RHTP-work funded by another state (Section 5.3.2)? If we are supporting another state with an initiative funded under the RHTP or other worked funded by RHTP, is this considered a duplication of effort?

A13: These are standard questions included in all of the State's RHT RFPs. For the opportunity the Offeror can provide a high level disclosure. The state does not anticipate funding awarded under this RFP will be duplicative of other RHT funding the offeror may receive.

Q14: Section 3.3 includes several requirements related to the Medicaid PACT model that appear to closely align with requirements included in RFP # 26-08RHT-010, DSS Rural Health Transformation Project Management. For example, both RFPs require support with design of the PACT model. Both also require stakeholder engagement for the PACT initiative inclusive of facilitating meetings. Can the State please further differentiate the PACT scope of work expectations under each RFP? Also, are vendors prohibited from being awarded contracts under both RFPs?

Can the State clarify how the vendor chosen for this RFP will collaborate on stakeholder engagement responsibilities with the vendor chosen for the vendor chosen for the Project Management RFP, RFP26-08RHT-010?

A14: The selected vendor for RFP #26-08RHT-008, Rural Health Transformation Primary Accountable Care Transformation Reimbursement Design, is primarily designing and refining the PACT reimbursement model and managing the stakeholder engagement necessary to provide input related to reimbursement design. There is need for collaboration between the selected vendor of RFP #26-08RHT-008 and RFP #26-08RHT-010, DSS Rural Health Transformation Project Management, as it related to coordinating stakeholder engagements that may address both the reimbursement model design as well as other, more operational aspects of the model that are the responsibility of the selected vendor for RFP #26-08RHT- 010, DSS Rural Health Transformation Project Management. The State is not aware of a specific prohibition against selecting the same vendor for multiple RFPs.

Q15: RFP Section 5.2 shows the required organization of the proposal. Please indicate where the bidder’s response to RFP Section 4.3 (Client References) should be placed in the bidder’s proposal.

A15: The Offeror’s response to RFP Section 4.3 should be places in the Detailed Response section of the proposal (5.2.3).

Q16:

Is DSS expecting a narrative response to RFP Section 6.1 (subsections 6.1.1. through 6.1.8) to be included in a bidder’s proposal?

Is DSS expecting a narrative response to RFP Section 6.2 through 6.5 to be included in a bidder’s proposal?

A16: A narrative response to RFP sections 6.1 through 6.5 do not necessarily need to be included in an Offeror’s proposal if the requirements and expectations of the sections are addressed elsewhere in the proposal.

Q17: RFP Section 7.1 states the cost proposal will be evaluated independently from the technical proposal. Does the State want the Cost proposal submitted as a separate proposal or should it be included with the technical proposal?

A17: The State does not have a preference regarding how the cost proposal is submitted.

Q18: Can DSS clarify the Cost Proposal breakout requirements? Specifically, are the example cost breakout categories listed in Section 7.4 intended to be exhaustive?

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A18: The State is requiring proposals to break out their costs related to subject matter expert(s) professional services time, conference call time, and travel expenses. If there are additional breakouts that reflect the completion of the Scope of Work, the proposal should reflect those.

Q19:

Would the State please provide additional guidance on how the budget should be presented?

For example, should it include more detail than labor hours by proposed staff by year?

Can the State confirm that there is no prescribed format or template for the Cost Proposal, and we may use our own?

A19: Applicants are encouraged to submit a time-based cost proposal with associated hourly rates. All costs related to the provision of the required services must be included in the cost proposal. At a minimum, proposals must break out costs related to subject matter expert(s) professional services time, conference call time, and travel expenses. The State does not prescribe a cost proposal format.

Q20: Please clarify what is meant by “Offerors may submit multiple cost proposals.”

A20: Offerors may present multiple cost models to best reflect the costs related to the provision of the required services.

Q21:

Should the submitted budget be for the 3-year base period only, or include the 2 one-year option periods as well?

Please confirm if the cost proposal should include the base period only, of if option years should be included.

A21: The cost proposal must include the base period and may optionally include the following optional two years.

Q22:

The RFP does not provide a budget cap or range. What is the state’s available budget range for this work?

What is the estimated budget or budget range for this project?

Would the State please share the "not to exceed" amount of this award?

What is the budget that has been approved or allocated for this effort?

Is there a maximum budget amount allocated for this scope of work?

A22: Vendors should submit a cost proposal reflecting their bid for completing the items in the scope of work. We anticipate cost proposals may range from $150,000 to $450,000 per year.

Q23: Would the State please clarify what is meant by "conference call time?"

A23: The State is considering “conference call time” as time the selected Vendor spends working with the State and the provider stakeholder groups to complete items in the Scope of Work.

Q24:

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Do you anticipate that this program will replace the current Primary Care Provider (PCP) Program, CareConnect Program, and BabyReady Program? If so, what are you hoping to accomplish beyond what those programs and the Health Home Program have accomplished?

Does the State anticipate that PACT will operate simultaneously with the Primary Care Provider Program and Care Connect?

A24: The State anticipates that the PACT program will replace the existing Primary Care Provider (PCP) Program. The Care Connect Program is anticipated to be folded into a larger model to incorporate new tools for data collection, case management, and population health, and streamline administration for providers and the State. PACT is designed to align incentives by rewarding quality and outcomes rather than service volume and support the financial viability of primary care providers long-term. BabyReady will not be replaced or altered but may benefit from the data collection and case management tools created through this effort.

Q25: The RFP does not specify which constituencies should be included in stakeholder engagement, though it alludes to some providers (e.g., FQHCs, RHCs and Indian Health Services). Does the state anticipate the contractor also engaging with Medicaid beneficiaries, statewide associations, or other groups? What role, if any, will the state play in connecting the contractor with the appropriate stakeholders?

A25: The contractor may be asked to contact or help arrange meetings with stakeholders, but any connections would be provided by the state.

Q26: Are there any primary care services beyond those listed in the RFP that are envisioned to be included in the primary care prospective payment system such as behavioral health (BH) services for mild to moderately severe BH conditions, pre-natal care, CLIA-waived services provided on-site, etc. or is that part of the planning process?

A26: The State currently envisions the population-based payments limited to evaluation and management services provided in non-institutional settings. The State expects the selected Vendor to refine the services to be included.

Q27: Can the State confirm that the vendor will need to define the code set to serve as the basis for the capitation?

A27: The selected Vendor will need to refine the code set that services as the basis for the capitated payments.

Q28: Will primary care provider entities that want to be enrolled in the programs be required to have a minimum number of assigned Medicaid beneficiaries? If so, what is that number?

A28: The State has not yet determined if provider entities will be required to have a minimum number of assigned Medicaid recipients on their case load.

Q29: Are primary care entities receiving case management funding expected to manage transitions of care of assigned beneficiaries being released from an emergency room or inpatient setting?

A29: The State is still refining the expectations of the case management component of the payment model. Primary care providers receiving case management funding would be expected to ensure there is appropriate follow-up initiated after release from an emergency room or inpatient hospitalization. This may include (but not limited to) tasks such as discharge follow-up phone calls, arranging/ensuring primary care follow-up appointments, other specialist appointments, labs, imaging, and other recommendations upon discharge.

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Q30: Does the State intend to allow all or some providers to opt-in/out of PACT, and carry on business as usual?

A30: The State anticipates PACT will also have a fee-for-service track for providers who do not wish to receive a population-based payment.

Q31:

Does the State intend PACT to cover all Medicaid or just non-dual eligible beneficiaries?

Are dual-eligible members to be considered as model participants?

Section 3.2 includes requirements related to determining the Medicaid recipients to include in the alternative payment methodology and how those recipients will be tiered. Does the State currently have an existing member attribution methodology used in other programs that should be considered as a starting point for the PACT model, or should the vendor assume that attribution methodology development is fully within the scope of this project?

A31: The State has a preliminary plan for which recipients will be included in the payment methodology that does not include dual eligibles. The selected vendor will refine which Medicaid recipients will be included in the alternative payment methodology and how recipients will be tiered within the methodology. Existing member attribution models are used by the State and may serve as an example for the PACT model.

Q32: The RFP does not describe the contractor supporting MMIS changes, though these may be necessary to implement population-based payments. What does the state anticipate in this regard?

A32: The State anticipates that MMIS changes will occur. These changes are outside the scope of this contract.

Q33: Will providers such as FQHCs and RHCs that are reimbursed at their unique prospective payment system (PPS) all-inclusive rates be eligible for a case management fee in addition?

A33: It is anticipated that the payment design will be flexible to include providers currently paid at an encounter rate such as Federally Qualified Health Centers, Rural Health Clinics, Indian Health Service Clinics, and Tribal 638 clinics.

Q34: Have FQHCs and/or RHCs in South Dakota expressed interest in transitioning from fee-for-service reimbursement under PPS to a prospective payment system?

A34: South Dakota FQHCs and RHCs are reimbursed at a PPS rate today, with some services carved out of the encounter and paid fee for service. Any changes to this aspect of the reimbursement structure for FQHCs and RHCs are not part of this Scope of Work. The State believes FQHC and RHC providers may be interested in being reimbursed under the PACT model’s primary care prospective population-based payment.

Q35: Do you intend to measure the cost-effectiveness of this program as you did with the Health Home program by comparing participants against a control group of individuals that would be eligible, but not participating in the program?

A35: The State has not yet determined how the cost-effectiveness of the program will be measured.

Q36: Do you already have a population health/care management platform that you will use to support this program, or will you have to procure such a platform?

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A36: The State is planning to procure a Vendor to provide a population health/case management tool.

Q37: Is there any consideration to adding a shared savings program opportunity for PCP entities whose attribution exceeds a certain threshold?

A37: The initial concept includes a value-based payment. At this time, we do not anticipate the model including shared savings.

Q38: Data Quality & Validation Expectations

Has DSS already conducted data validation or completeness assessments, or is validation fully the bidder’s responsibility?

Are there known data limitations (e.g., lag, missing provider attribution, managed care carve-outs) bidders should plan around?

Historical Period Definition Does the State expect the historical baseline to be based on calendar years, state fiscal years, or rolling periods?

Are any years impacted by COVID related anomalies expected to be excluded or adjusted?

A38: The State expects the selected vendor to validate the historical primary care costs using claims data provided by the State. Data limitations depend on many factors and would be noted by the State when the claims data is provided to the selected vendor. The State is open to discussing options for the historical period. The selected vendor may suggest excluding or adjusting any data impacted by COVID.

Q39: Would the State please clarify what is meant by "subject matter expert" in this context?

Is the State referring to contractor staff or outside experts such as consultants?

A39: The State is referring to contractor staff as subject matter experts.

Q40: What level of assistance does the State anticipate needing in order to draft either a SPA or 1115 waiver demonstration application?

A40: The State anticipates the selected vendor to assist in drafting the content of the SPA or 1115 Waiver demonstration application specific to the payment model and rate methodology.

The State anticipates this may include drafting and refining content.

Q41: To what extent does the State expect the selected vendor to challenge or materially revise the preliminary model concept in Attachment B?

A41: The State expects the selected vendor to refine the preliminary model concept in Attachment B as described in the Scope of Work.

Q42:

Would the State plan to provide the vendor with access to the Medicaid data or would the contractor receive an extract?

What data will the Division share with the contractor to enable modeling of the payment model options?

Will historical adjudicated claims be made available as input to the model to inform the design and operation of the program?

A42: The State anticipates providing the selected vendor with Medicaid claims data as an extract(s). The content is to be determined by the State and the selected vendor.

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Q43: What data (encounters, costs, wrap/settlement detail) will be available for providers receiving an encounter rate, and does the State have any non-negotiable constraints on how encounter payments must be preserved or transformed?

A43: The data points available for providers receiving an encounter rate will be determined by the State and the selected vendor. There are not currently non-negotiable constraints on preserving encounter payments, but they may be established in conversation between the State and the selected vendor.

Q44:

Section 3.2 indicates that the selected vendor will validate historical primary care costs using Medicaid claims data provided by the Division of Medical Services. Can the State clarify the expected timeline for providing the initial data extracts following contract execution?

For planning purposes, can the state provide an estimate of how long it will take to access the Medicaid claims data or receive a data file following the start of contract?

A44: The State anticipates providing claims data extracts within 30 days of the establishment of the level of detail as determined by the State and the selected vendor.

Q45:

Is the intent to have the vendor generate HEDIS results (if determined to be used for this program), or will the HEDIS results be provided as input to the model?

Does DSS have a selected vendor to calculate the NCQA HEDIS measures indicated in attachment B?

A45: The State intends to generate HEDIS results and provide them as input for the model developed as a result of this Scope of Work.

Q46: Regarding historical data:

o What years of Medicaid claims and enrollment data will be provided for historical analysis?

o Will data include encounter data for FQHCs, RHCs, IHS, and Tribal 638 providers, and if so, in what format?

o Will pharmacy, behavioral health, and non-primary care claims be included to support risk adjustment and utilization trend analysis?

Regarding claims and encounters data:

What record types are included?

Fee-for-service (FFS) claims Managed care encounters Pharmacy claims (separate PBM feed or integrated?)

Capitation / payment records

Are denied, voided, and adjusted claims included?

Are there both original and final versions of claims, or only final-action claims? o Logical structure Is the data:

Claim-level only?

Claim + line-level?

Header/line split with parent keys?

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How are multi-line claims represented?

Are reversals and adjustments new rows or updates to existing rows? o Keys What is the stable unique identifier for:

Claim Claim line Member Provider

Do claim IDs persist across adjustments?

Supporting records

Eligibility/enrollment files (monthly snapshots vs daily) Provider files (NPI/TIN, taxonomy, affiliations) Managed care plan reference files Diagnosis/procedure reference crosswalks (if state-specific) National standards Are diagnosis codes ICD-9/ICD-10 mixed historically?

Procedures: CPT, HCPCS, state-specific codes?

Drug coding:

NDC 11-digit normalized?

Raw 10-digit?

Compound handling?

Revenue codes, Place of Service, Bill Type, DRGs, APCs included?

Members What member ID(s) are provided?

Does the member ID persist across:

Managed care plans?

Eligibility spans?

Redeterminations?

Are SSNs, masked IDs, or crosswalks ever provided?

How are dual-eligibles represented?

Providers NPI vs Medicaid provider ID vs TIN How are:

Rendering provider Billing provider Prescribing provider represented?

Are historical NPIs retained when providers re-enroll?

Dates, Timing & Lags Dates available:

Date of service (from/to) Claim receipt date

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Adjudication date Payment date Adjustment date

Which date does the state recommend for:

Utilization analysis?

Financial reporting?

Typical lag:

FFS claims MCO encounters Pharmacy claims How far back can claims be restated or adjusted?

Financial Fields & Payment Logic What financial fields are included?

Billed amount Allowed amount Paid amount Member liability (copay, spend-down)

Are amounts:

Line-level?

Header-level?

How are zero-paid encounters represented?

How are capitation payments linked (if at all) to utilization?

Data Quality, Completeness, Known Issues Are there known:

Missing fields?

Under-reported services?

Historical gaps?

What percentage of claims are typically considered incomplete?

Missing eligibility Missing provider Undefined codes (HCPCS, ICD10, etc)

Are encounter completeness metrics available?

Are edits or validation rules applied before release?

Is there a data quality or release notes document per delivery?

Validation and Reconciliation Are control totals provided?

Claim counts Dollar totals

Is there a point of contact for data questions/issues SLA for issue resolution?

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A46: Once an offeror is awarded and under contract, the State will collaborate with the vendor regarding the necessary data to inform modeling and recommendations.