RFP 2025-06 ESRD Population Risk-Based Management.pdf

RFP 2025-06 ESRD Population Risk-Based Management Services

REQUEST FOR PROPOSALS #2025-06

ESRD Population Risk-Based Management Publish Date: December 8, 2025

CareOregon, Inc. (“CareOregon”) and Health Plan of CareOregon (CareOregon Advantage), are inviting submission of proposals for the ESRD Population Risk-Based Management project.

Closing Date/Time: January 6, 2026 - 2:00 PM, Pacific Time.

Project Summary: CareOregon is seeking a risk bearing entity to design and provide proactive population health management for members with early-stage kidney disease through End Stage Renal Disease (ESRD), provide a kidney care program, and ensure members are receiving all benefits they are entitled

to. Work is to begin in February, 2026, continuing for a three-year period with the option of two (2) one

(1) year renewals thereafter.

Contact Information: The sole point of contact for procurement process or technical questions is: Lee

Reinholtz, Procurement & Contract Analyst II; reinholtzl@careoregon.org;

503-416-1797

RFP Location: RFP Documents can be downloaded from OregonBuys at the following address:

https://oregonbuys.gov/bso/. Prospective Proposers will need to sign in to download the information and that information will be accumulated for a Plan Holder's List. Prospective Proposers are responsible for obtaining any Addenda or clarifying questions from OregonBuys.

Submission: All proposals must be emailed to vendorservices@careoregon.org. Do not attempt to submit proposals through or to the OregonBuys website. All proposals must be submitted to the email listed above.

CareOregon encourages proposals from minority, women, service-disabled veteran, and emerging small businesses.

**NO PROPOSALS WILL BE RECEIVED OR CONSIDERED AFTER THE ABOVE

RFP CLOSING DATE/TIME**

SCHEDULE

Request for Proposals Issued…….................................................. December 8, 2025

Deadline to Submit Clarifying Questions....................................... December 22, 2025, 5:00 PM, Pacific Time

Request for Proposals Closing Date and Time (“Closing”)........... January 6, 2026, 2:00 PM, Pacific Time

Anticipated Contract Start Date……..............................................February 2026 mailto:reinholtzl@careoregon.org https://oregonbuys.gov/bso/ mailto:vendorservices@careoregon.org

SECTION 2

INSTRUCTIONS TO PROPOSERS

2.1 Modification or Withdrawal of Proposal: Any Proposal may be modified or withdrawn at any time prior to the Closing deadline, provided that a written request is received by Procurement, prior to the Closing. The withdrawal of a Proposal will not prejudice the right of a Proposer to submit a new Proposal.

2.2 Requests for Clarification and Requests for Change: Proposers may submit questions regarding the specifications of the RFP until the deadline in the Schedule. Requests for changes must include the reason for the change and any proposed changes to the requirements. The purpose of this requirement is to permit CareOregon to correct, prior to the opening of Proposals, RFP terms or technical requirements that may be unlawful, improvident or which unjustifiably restrict competition. CareOregon will consider all requested changes and, if appropriate, amend the RFP. No oral or written instructions or information concerning this RFP from CareOregon employees or agents to prospective Proposers shall bind CareOregon unless included in an Addendum to the RFP.

2.3 Addenda: If any part of this RFP is changed, an addendum will be published on OregonBuys. It shall be Proposers responsibility to regularly check OregonBuys for any notices, published addenda, or response to clarifying questions.

2.4 Submission of Proposals: Proposals must be submitted in accordance with Section 5. All Proposals must include a signature that affirms the Proposer’s intent to be bound by the Proposal (this may be on cover letter, or on the Proposal). The Certification page must be signed as well. If a Proposal is submitted by a firm or partnership, the name and address of the firm or partnership shall be shown, together with the names and addresses of the members.

If the Proposal is submitted by a corporation, it shall be signed in the name of such corporation by an official who is authorized to bind the contractor. No late Proposals will be accepted.

2.5 Acceptance of Contractual Requirements: Failure of the selected Proposer to execute a contract and deliver required insurance certificates within ten (10) calendar days after notification of an award may result in cancellation of the award. This time period may be extended at the option of CareOregon.

2.6 Investigation of References: CareOregon reserves the right to investigate all references in addition to those supplied references and investigate past performance of any Proposer with respect to its successful performance of similar services, its compliance with specifications and contractual obligations, its completion or delivery of a project on schedule, its lawful payment of subcontractors and workers, and any other factor relevant to this RFP. CareOregon may postpone the award or the execution of the contract after the announcement of the apparent successful Proposer in order to complete its investigation.

2.7 RFP Proposal Preparation Costs and Other Costs: Proposer costs of developing the Proposal, cost of attendance at an interview (if requested by CareOregon), or any other costs are entirely the responsibility of the Proposer, and will not be reimbursed in any manner by CareOregon.

2.8 Clarification and Clarity: CareOregon reserves the right to seek clarification of each Proposal, or to make an award without further discussion of Proposals received. Therefore, it is important that each Proposal be submitted initially in the most complete, clear, and favorable manner possible.

2.9 Right to Reject Proposals: CareOregon reserves the right to reject any or all Proposals or to withdraw any item from the award, if such rejection or withdrawal would be in CareOregon’s interest, as determined by CareOregon.

Proposals may be rejected in whole or in part if they attempt to limit or modify any of the terms, conditions, or specifications of the RFP or the Sample Contract.

2.10 Proposal Terms: All Proposals, including any price quotations, will be valid and firm through a period of one hundred and eighty (180) calendar days following the Closing date. CareOregon may require an extension of this firm offer period. Proposers will be required to agree to the longer time frame in order to be further considered in the procurement process.

2.11 Oral Presentations: At CareOregon’s sole option, Proposers may be required to give an oral presentation of their Proposals to CareOregon, a process which would provide an opportunity for the Proposer to clarify or elaborate on the Proposal but will in no material way change Proposer’s original Proposal. Any costs of participating in such presentations will be borne solely by Proposer and will not be reimbursed by CareOregon. Note: Oral presentations are at the discretion of the evaluating committee and may not be conducted; therefore, written Proposals should be complete.

2.12 Review for Responsiveness: Upon receipt of all Proposals, the Procurement Department will determine the responsiveness of all Proposals before submitting them to the evaluation committee. If a Proposal is incomplete or non-responsive in significant part or in whole, it will be rejected and will not be submitted to the evaluation committee.

CareOregon reserves the right to determine if an inadvertent error is solely clerical or is a minor informality which may be waived, and then to determine if an error is grounds for disqualifying a Proposal. The Proposer’s contact person identified on the Proposal will be notified, identifying the reason(s) the Proposal is non-responsive.

2.13 Communication Blackout Period: Except as called for in this RFP, Proposers may not communicate with members of the Evaluation Committee or other CareOregon employees or representatives about the RFP during the procurement process until the apparent successful Proposer is selected. Communication in violation of this restriction may result in rejection of a Proposer.

2.14 Prohibition on Commissions and Subcontractors: CareOregon will contract directly with persons/entities capable of performing the requirements of this RFP. Contractors must be represented directly. Participation by brokers or commissioned agents will not be allowed during the Proposal process. Contractor shall not use subcontractors to perform the Work unless specifically proposed or authorized to do so by CareOregon. Contractor represents that any employees assigned to perform the Work, and any authorized subcontractors performing the Work, are fully qualified to perform the tasks assigned to them, and shall perform the Work in a competent and professional manner. Contractor shall not be permitted to add on any fee or charge for subcontractor Work. Contractor shall provide, if requested, any documents relating to subcontractor’s qualifications to perform required Work.

2.15 Collusion: By responding, the Proposer states that the Proposal is not made in connection with any competing Proposer submitting a separate response to the RFP, and is in all aspects fair and without collusion or fraud. Proposer also certifies that no officer, agent, or employee of CareOregon has a pecuniary interest in this Proposal.

2.16 Evaluation Committee: Proposals will be evaluated by a committee consisting of representatives from CareOregon and potentially external representatives. CareOregon reserves the right to modify the make-up in its sole discretion.

2.17 Nondiscrimination: The successful Proposer agrees that, in performing the Work called for by this RFP and in securing and supplying materials, contractor will not discriminate against or treat differently, any person on the basis of race, color, religious creed, political ideas, sex, age, marital status, sexual orientation, gender identity, veteran status, physical or mental disability, national origin or ancestry, or any other class protected by applicable law.

2.18 Best and Final Offer: CareOregon may request best and final offers from those Proposers determined by CareOregon to be reasonably viable for contract award. However, CareOregon reserves the right to award a contract on the basis of initial Proposal received. Therefore, each Proposal should contain the Proposer’s best terms from a price and technical standpoint. Following evaluation of the best and final offers, CareOregon may select for final contract negotiations/execution the offers that are most advantageous to CareOregon, considering cost and the evaluation criteria in this RFP.

2.19 PROPOSAL CONFIDENTIALITY: Submitted proposals will be treated as confidential and will only be shared internally with applicable staff for this project. Proposers that responded to the RFP will be notified of the award at the completion of the process. Proposer scores and evaluation notes shall remain private and confidential information for CareOregon purposes only.

SECTION 3

SCOPE OF WORK

3.1 BACKGROUND

Founded in 1993, CareOregon is a 501(c)(3) public benefit nonprofit company that draws nearly all its revenue from public programs such as Medicaid (the Oregon Health Plan – “OHP”), Medicare and the State Children’s Health Insurance Program (“SCHIP”). Coordinated care organizations (“CCOs”) are an Oregon innovation that integrates physical, behavioral and oral health care, and treats the whole person.

Through partnerships with our CCOs, we provide integrated managed care services. We partner with Health Share of Oregon to serve the tri-county Portland metro area. We own Jackson Care Connect and Columbia Pacific CCO. In addition to Medicare plans and CareOregon Dental lines of business, Housecall Providers delivers primary, palliative and hospice care to home-bound patients.

Our mission is to inspire and partner to create quality and equity in individual and community health.

Our vision is healthy communities for all individuals, regardless of income or social circumstances.

We focus on the total health of our members, not just traditional health care. In teaming up with members, their families and their communities, we help Oregonians live better lives, prevent illness and respond effectively to health issues.

We care about people We serve Oregonians eligible for the OHP and Medicare Advantage members who have us as their health care option. But that’s not all. We are a managed health care company with an overarching goal: to make world-class, high-quality health care available to all Oregon residents, regardless of income.

We support our neighbors We know that some Oregonians are in need but don’t qualify for OHP benefits. We work to strengthen the health care safety net that these Oregonians rely upon, from local health departments and community clinics to rural and migrant health centers. We partner with policy makers and legislators to improve services and provide access to quality care throughout the state, from urban centers to rural neighborhoods.

We work with first-class providers CareOregon has built a health care delivery system that assures access to physicians and health care professionals who understand special needs and provide quality care regardless of a patient’s financial resources.

We work with policy makers to ensure access We provide OHP enrollees access to health care services in exchange for a per member, per month capitation rate. The Oregon Legislature sets this payment rate. The payments are subject to available state funding. CareOregon takes full financial risk for the health care services our members use. CareOregon, formed by safety net health care providers in the state, is a Safety Net Health Plan. Safety Net Health Plans are nonprofits that derive their revenue from public programs.

To put it simply, CareOregon ensures that members have timely access to high quality health care from a broad network of providers, and CareOregon works hard every day to keep people healthy and active in their homes and communities.

Equity, Diversity, and Inclusion:

CareOregon recognizes that to achieve the vision of “Healthy communities for all individuals, regardless of income or social circumstances,” it must intentionally cultivate authentic member engagement, community partnerships, and recruit, retain and develop a staff as diverse as the communities it serves.

CareOregon has embarked on a continuous effort to understand the effects of historical, institutional and structural oppression on the various communities represented within its membership and personnel.

CareOregon strives to internally, and in partnership with other like-minded organizations across sectors, to redress policies, systems and health related environmental issues that affect health care disparities and inequities.

Equity, diversity, and inclusion is a cornerstone of CareOregon’s mission, vision and strategic objectives.

CareOregon’s priority is strengthening our communities by making health care work for everyone by ensuring access to a broader and more diverse network of physical, behavioral, and oral health services that address the individual needs and cultural values of our members and reduces barriers to getting needed care.

It is the intent of CareOregon, through issuance of this RFP, to collaborate with like-minded firms that share the same values and that will take actual steps to embody those values in the services provided to CareOregon and its providers, members and clients.

Project Background:

CareOregon operates a Dual Eligible Special Needs Plan (“D-SNP”) Medicare Advantage plan (CareOregon Advantage). There are roughly 200-250 members at any given time enrolled in this plan with End Stage Renal Disease (“ESRD”). This population represents a significant clinical and financial challenge due to complex care needs and high utilization of dialysis and related services. Historically, CareOregon Advantage has reimbursed providers on a fee-for-service basis for ESRD-related care. While this approach has ensured access to necessary services, it has also resulted in cost variability and limited opportunities for integrated care management.

3.2 SCOPE OF WORK

3.2.1 Scope:

CareOregon is seeking a risk bearing entity to design and provide proactive population health management for members with early-stage kidney disease through End Stage Renal Disease (ESRD), provide a kidney care program, as well as ensure members are receiving all benefits they are entitled to.

Proactive population health management services for members with early-stage kidney disease through ESRD shall include the following Services:

Medical Management

• Early identification and stratification of patients with chronic kidney disease (CKD) and

ESRD.

• Identify and intervene early/proactively with members who have early-stage kidney disease.

• Create initiatives to increase the proportion of clinic-based and home-based dialysis and to increase the proportion of peritoneal dialysis versus hemodialysis where medically appropriate.

• Program management must incorporate culturally competent care and social determinants of health-related initiatives.

• Care management, including coordination of medical and support services.

• Employ virtual or telehealth care service options for members.

• Manage provider feedback, complaints, and questions regarding patients or

Proposer’s services.

• Pre and post kidney transplant care coordination.

• Provide enrollment assistance services.

• Reduce inpatient admissions for members with ESRD.

• Ensure continuity of care during transitions (hospital to home, dialysis center to transplant).

• Management of nephrology services and dialysis network relationships.

• Establish value-based agreements with providers of primary care, specialty care, and dialysis providers to incentivize quality, financial equity, health equity, and growth outcomes.

• Promote integrated model of care for primary care, specialty care, kidney transplant services, and dialysis providers.

• Manage kidney disease members’ medication adherence as evidenced by Healthcare Effectiveness Data and Information Set (“HEDIS”) medication adherence measures.

• Establish utilization management and accounting process to optimize utilization of the various types of renal replacement therapy.

• Member engagement and education to support self-management and adherence.

• Leverage data to promote member-centric interventions in the areas of education, self-monitoring, diet, and self-motivation.

• Use technology to support care coordination and member engagement to reduce hospitalization.

• Improve member experience.

• Address social determinants of health (SDOH) for ESRD and CKD members.

• Provide additional population management services or tools the Proposer may offer.

Risk Adjustment and Quality

• Ensure accurate and complete risk adjustment documentation for CKD and ESRD populations.

• Implement processes for closing care gaps and improving relevant Star measure performance.

• Provide reporting and analytics to monitor risk adjustment accuracy and quality outcomes.

• Provide advanced data analytics and reporting capabilities, including real-time and self-service reporting options with data visualization, cost of care, care options, and care outcome benchmarking. Must meet NCQA guidelines.

• Create workflows and/or reporting that leverage advanced analytical techniques such as use of predictive analytics or artificial intelligence.

Financial Management

• CareOregon prefers Proposer to assume financial accountability for the ESRD population under a risk-sharing arrangement, up to full capitation.

• Implement processes for cost management, utilization oversight, and financial reporting.

• Deliver timely and accurate reporting on clinical, financial, and operational performance.

• Offer innovative solutions (e.g., predictive analytics, telehealth) to improve cost predictability and member outcomes.

• Maximize member’s benefit potential with an emphasis on converting eligible Medicaid members to Medicare ESRD with Medicare Advantage as appropriate.

• Establish targets for utilization and cost of care by type of renal replacement therapy.

Compliance

• Maintain compliance with CMS and state regulations, including Health Insurance Portability and Accountability Act (“HIPAA”) and audit readiness.

• Support CareOregon’s compliance program through proactive monitoring and corrective action as needed.

• Meet CareOregon Data Security Requirements as described in the attached Sample Contract.

Implementation.

• Proposer to provide implementation of the services as required.

• Proposer to support post go-live on an ongoing basis, to include resources.

• Proposer to provide Service Level Agreement and escalation protocols, if applicable.

• CareOregon may assist in the implementation process, if applicable.

Qualifications.

Proposers must meet the following minimum qualifications:

• Proposer must be a risk bearing entity and shall assume certain medical expenses.

• Knowledge of and demonstrated experience with the following populations: public sector

(Medicaid and Medicaid Managed Care), early-stage kidney disease (CKD 3, CKD 4), ESRD, and CKD 2 populations, if relevant.

• Knowledge of and demonstrated experience with implementing payor strategies, CMS Kidney Care Choices Models, and other value-based agreements.

• Experience with the Medicare Advantage population.

• Expertise in use of HEDIS data as part of a population health management strategy for kidney disease and co-morbidities.

• Expertise in relevant care managements standards, including those maintained by NCQA, OHA, and CMS.

• Demonstrated track record of standing up a kidney care program within six (6) month or less for an insurance company.

• Ability to customize programming at both the client and state level.

3.2.2 Work Schedule:

The table outlines target timelines for this project. It is important for Proposers to highlight their ability to meet these timelines or to propose alternatives based on their recommendations.

Contract execution date February 16, 2026 Anticipated go-live date March 5, 2026 Ongoing support begins March 5, 2026 Monthly meeting with CareOregon contract administrator

Ongoing through contract term.

3.2.3 Term of Contract: The term of the contract shall be from the effective date through December

31, 2028, with the option for two (2) additional one (1) year renewals thereafter subject to the mutual agreement of the parties. The term will include a 90-day termination for convenience clause that is not negotiable.

3.2.4 Sample Contract: Submission of a Proposal in response to this RFP indicates Proposer’s willingness to enter into a contract containing substantially the same terms (including insurance requirements) of the sample contract identified below. No action or response to the sample contract is required under this RFP. Any objections to the sample contract terms should be raised in accordance with Paragraphs 2.2 of this RFP pertaining to requests for clarification of the

RFP/specifications. This RFP and all supplemental information in response to this RFP will be a binding part of the final contract.

The applicable Sample [Professional Services Contract for this RFP can be found at https://careoregon.org/contact-us/vendor-resources.

Professional Services Contract (unless checked, item does not apply) The following paragraphs of the Professional Services Contract will be applicable:

Travel and Other Expense is Authorized Protection of Patient Privacy and Security (PHI) Criminal Background Check Requirements Key Persons On-Call Contract Basis CareOregon Data Security Requirements Hosted Software

The following insurance requirements will be applicable:

Commercial General Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence, with an annual aggregate limit of $2,000,000 for Bodily Injury and Property Damage.

Professional Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence, with an annual aggregate limit of $2,000,000 for damages caused by error, omission, or negligent acts.

Automobile Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence for Bodily Injury and Property Damage.

Cyber Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence for network security (including data breach), privacy, interruption of business, media liability, and errors and omissions.

For Software Purchases It is understood that most software purchases will be completed using the Proposer specific contract template. For this project, CareOregon is open to using the selected Proposer contract, however, the attached Contract Addendum (attached as Exhibit B) shall be required to be executed that will specifically supersede several typical clauses contained in the Proposer’s software agreements. Most of the clauses are required and will not be negotiated so it is important for interested Proposers to carefully read the Contract Addendum and understand that it will be executed along with the resulting Proposer contract.

https://careoregon.org/contact-us/vendor-resources

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SECTION 4

EVALUATION PROCEDURE

4.1 An evaluation committee will review all Proposals that are initially deemed responsive and they shall rank the Proposals in accordance with the below criteria. The evaluation committee may recommend an award based solely on the written responses or may request Proposal interviews/presentations.

Interviews/presentations, if deemed beneficial by the evaluation committee, will consist of the highest scoring Proposers. The invited Proposers will be notified of the time, place, and format of the interview/presentation. Based on the interview/presentation, the evaluation committee may revise their scoring.

Written Proposals must be complete and no additions, deletions, or substitutions will be permitted during the interview/presentation (if any). The evaluation committee will recommend award of a contract to the final CareOregon decision maker based on the highest scoring Proposal. The CareOregon decision maker reserves the right to accept the recommendation, award to a different Proposer, or reject all Proposals and cancel the RFP.

Proposers are not permitted to directly communicate with any member of the evaluation committee during the evaluation process. All communication must be facilitated through the assigned Procurement Analyst.

4.2 Evaluation Criteria

Category Points available:

Proposer’s General Background and Qualifications 0-30 Scope of Work 0-35 Equity, Diversity, and Inclusion Efforts 0-10 Fees 0-25

Available points 0-100

4.3 Once a selection has been made, CareOregon will enter into contract negotiations. During negotiation, CareOregon may require any additional information it deems necessary to clarify the approach and understanding of the requested services. Any changes agreed upon during contract negotiations will become part of the final contract. The negotiations will identify a level of Work and associated fee that best represents the efforts required. If CareOregon is unable to come to terms with the highest scoring Proposer, discussions shall be terminated and negotiations will begin with the next highest scoring Proposer. If the resulting contract contemplates multiple phases and CareOregon deems it is in its interest to not authorize any particular phase, it reserves the right to return to this solicitation and commence negotiations with the next highest ranked Proposer to complete the remaining phases.

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SECTION 5

PROPOSAL CONTENTS

5.1 Vendors must adhere to submission instructions and be advised as follows:

a. Complete Proposals must be emailed to vendorservices@careoregon.org. The subject line of the email must identify the RFP title. Proposers are encouraged to contact Procurement to confirm receipt of the Proposal.

b. CareOregon reserves the right to solicit additional information or Proposal clarification from the vendors, or any one vendor, should CareOregon deem such information necessary.

c. Proposal may not exceed a total of 15 pages (single-sided), inclusive of all exhibits, attachments, or other information.

d. Proposers are required to structure Proposals following the below question outline. It is important for answers to be clear and concise.

5.2 Proposer’s General Background and Qualifications (30 Max points):

a. Description of the firm.

i. How many years has your organization been in business?

ii. What geographic areas do you currently serve, and which provider networks do you partner with? how many providers are in your network in the Portland Oregon area?

iii. Describe your experience working with nonprofit health plans of similar size and structure.

Provide examples of partnerships with D-SNP plans.

iv. Have you been subject to any federal or state citations, corrective action plans, or contract terminations for cause?

b. Credentials/experience of key individuals that would be assigned to this project.

c. Description of providing similar services to non-profit entities of similar size within the past five (5) years.

d. Describe your typical customer profile, such as size and service provided. What are your customer retention rates?

e. Description of the firm’s ability to meet the requirements in Section 3.

f. Description of what distinguishes the firm from other firms performing a similar service.

g. Describe if any of the proposed services will be performed by offshore (not US state or US territory) employees or subcontractors?

h. Describe if your firm is currently or potentially engaged in litigation.

i. Provide information demonstrating that your firm is financially stable.

j. Identify any issues or concerns in social media about your firm?

5.3 Scope of Work (35 Max points):

Clinical Model and Outcomes

a. Describe your care model for managing CKD and ESRD populations.

b. What clinical and administrative staffing model supports your ESRD program?

c. How do you ensure continuity of care during transitions (e.g., hospital to home, dialysis center to transplant)?

d. What efforts will you make to increase the proportion of clinic-based and home-based dialysis, and to increase the proportion of peritoneal dialysis versus hemodialysis where medically appropriate?

e. What capabilities and services do you provide to ensure care gap closure and accurate risk adjustment documentation?

f. How does your organization integrate care coordination across nephrology, primary care, and social support services?

g. How do you leverage data to identify high-risk members and intervene early?

h. What technology or tools do you use to support care coordination and member engagement?

i. How do you measure success in care coordination (e.g., reduced hospitalizations, improved adherence)?

j. Provide historical outcomes, including transplant rates and other relevant clinical metrics.

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k. What are your key performance indicators (KPIs) and outcome measures?

Quality and Member Experience

a. How do you engage members in self-management and education for CKD/ESRD?

b. What strategies do you employ to improve member experience and satisfaction?

c. How do you address social determinants of health (SDOH) for ESRD and CKD members?

Financial Model

a. What risk-sharing arrangements are you willing to take on, up to full capitation, and for which populations?

b. Will your financial model include all medical expenses or be limited to specific services? Please describe your standard approach.

c. Provide examples of financial outcomes or savings achieved in other agreements.

d. What reporting mechanisms do you use to share performance, financial, and clinical data?

e. How many members are you currently managing under a risk-bearing arrangement?

Implementation

a. If applicable, provide an implementation plan and estimated timeline from a hypothetical contract execution date.

b. If applicable, are implementation services provided by your company or subcontracted to a third-party vendor?

c. If applicable, provide your standard Service Level Agreement.

Compliance

a. Describe your compliance program and processes for adhering to CMS and state regulations.

b. How do you ensure HIPAA compliance and data security in care management and reporting?

c. What proactive measures do you take to maintain CMS audit readiness?

Additional Information

a. What additional recommendations or relevant offerings would you like to share that could enhance member outcomes or financial performance?

5.4 Equity, Diversity, and Inclusion Efforts (10 Max points):

1. Describe your firm’s equity, diversity and inclusion values, policies, efforts, and successes. Include specific details of efforts and how they have shaped the composition and spirit of your firm.

2. Supplier diversity is the intentional inclusion of historically underutilized businesses in a firm’s supply base to achieve innovation, cost reduction, and building economic growth in our communities. If you plan to use subcontractors or other third-party services for the services proposed to CareOregon, describe your supplier diversity program.

3. Outline the specific elements of your proposed services that will support and advance CareOregon’s equity, diversity, and inclusion mission.

5.5 Fees (25 Max points):

1. What are Proposer’s fees, which shall be firm for the initial term of the Contract. Possible fee basis options:

a. Risk bearing. Describe risk-based arrangements you are willing to take on, or

b. Fixed Fee. Provide a fixed fee to complete the project, or

c. T&M. Provide fees on a time and materials basis with a not-to-exceed price to complete the project, or:

d. Contingency. Provide a contingency fee percentage of the total savings resulting from the data mining services.

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2. Outline any escalation of fees after the initial term, which shall be firm for the duration of the renewal term. Any escalation fee shall not exceed two percent (2%) over the prior term fee.

3. If applicable, provide a fee for software implementation. List an hourly fee and then estimate the total hours for implementation completion. List the estimated total fee for implementation.

4. Include any applicable administrative fees. Note: This fee is expected to be zero ($0.00) dollars.

5. If applicable, provide a fee for software maintenance and support services. List an hourly fee for support services. Also provide information about available service packages if applicable, priced annually. Include your firm’s Service Level Agreement.

6. There are NO additional fees (beyond those outlined in the Fees Section) required to administer the services outlined in this RFP. Any mandatory fees must be clearly outlined in the Fees Section of Proposer’s Proposal.

5.6 References (No points awarded).

Provide at least three (3) references from clients your firm has served similar to CareOregon in the past three (3) years, including one client that has newly engaged the firm in the past thirty-six (36) months and one (1) long-term client. Provide the name, address, email, and phone number of the references. Please note the required three references may not be from CareOregon staff, but additional references may be supplied. Points awarded for this criteria are based on both the providing of references as well as information gleaned from the provided contacts. Evaluation Committee members may contact references at their sole discretion.

5.7 Completed Proposal Certification (see the form below)

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PROPOSAL CERTIFICATION

RFP #2025-06 ESRD Population Risk-Based Management

Submitted by:

(Must be entity’s full legal name, and State of Formation)

Each Proposer must read, complete and submit a copy of this Proposal Certification with their Proposal. Failure to do so may result in rejection of the Proposal. By signature on this Proposal Certification, the undersigned certifies that they are authorized to act on behalf of the Proposer and that under penalty of perjury, the undersigned will comply with the following:

SECTION I. NONDISCRIMINATION: That the Proposer has not and will not discriminate in its employment practices with regard to race, color, creed, age, religious affiliation, sex, marital status, disability, sexual orientation, gender identity, national origin, veteran status, or any other protected class. Nor has Proposer or will Proposer discriminate against a subcontractor in the awarding of a subcontract because the subcontractor is a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business that is certified under ORS 200.055.

SECTION II. CONFLICT OF INTEREST: The undersigned hereby certifies that no officer, agent or employee of CareOregon is personally interested, directly or indirectly, in any resulting contract from this RFP, or the compensation to be paid under such contract, and that no representation, statements (oral or in writing), of the CareOregon, its officers, agents, or employees had induced Proposer to submit this Proposal. In addition, the undersigned hereby certifies that this proposal is made without connection with any person, firm, or corporation submitting a proposal for the same material, and is in all respects fair and without collusion or fraud.

SECTION III. COMPLIANCE WITH SOLICITATION: The undersigned further agrees and certifies that they:

1. Have read, understand and agree to be bound by and comply with all requirements, instructions, specifications, terms and conditions of the RFP (including any attachments);

2. Are an authorized representative of the Proposer, that the information provided is true and accurate, and that providing incorrect or incomplete information may be cause for rejection of the Proposal or contract termination; and

3. Will furnish the designated item(s) and/or service(s) in accordance with the RFP and Proposal.

Name:_______________________________________ Date:______________________________________

Signature:____________________________________ Title:______________________________________

Email:_______________________________________ Phone:_____________________________________

Oregon Business Registry Number:________________ OR CCB # (if applicable):________________________

Proposer Primary Point of Contact (Coordination during process and for award information):

Name:_______________________________________

Email:_______________________________________ Phone:_____________________________________

Business Designation (check one):

Corporation Partnership Sole Proprietorship Non-Profit Limited Liability Company

Minority (MBE), Women (WBE), Service-Disabled Veteran (SDV), and Emerging Small Business (ESB):

Certified by the State of Oregon (provide certification number as applicable):

MBE WBE SDV ESB

Self-identified (check as applicable):

MBE WBE SDV ESB

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PROFESSIONAL SERVICES CONTRACT

Contract #

EXHIBIT A

SAMPLE CONTRACT – DO NOT SIGN

This Professional Services Contract (this “Contract”) is entered into between (“Contractor”), and CareOregon, Inc. (“CareOregon”), each individually a “Party” and collectively, the “Parties”.

ARTICLE I.

1. Effective Date and Duration. This Contract shall become effective upon signature of both Parties (“Effective Date”). Unless earlier terminated or extended, this Contract shall expire on .

2. Scope of Work. Contractor shall provide the following professional services: (“Work”), further described in Exhibit A.

3. Compensation. CareOregon agrees to pay Contractor a sum not to exceed Write Out Number dollars ($ ) (“NTE”), for accomplishing the Work required by this Contract. Consideration rates are on a [time and materials] [fixed fee] basis in accordance with the rates and costs specified in Exhibit A. If any interim payments to Contractor are made, such payments shall be made only in accordance with the schedule and requirements in Exhibit A.

4. Invoices and Payments. Unless otherwise specified, Contractor shall submit monthly invoices for

Work performed. Invoices shall include the above contract number and describe all Work performed with particularity, by whom it was performed, and shall itemize and explain all expenses for which reimbursement is claimed. The invoices shall include the total amount billed to date by Contractor prior to the current invoice. If Contractor fails to present invoices in proper form within sixty (60) calendar days after the end of the month in which the services were rendered, Contractor waives any rights to present such invoice thereafter and to receive payment therefor. Payments are normally made within 30 days following the date an accurate invoice is received. Contractor may not assess an overdue account charge in excess of eight percent (8%) per annum on outstanding balances in accordance with ORS

293.462. Contractor shall not submit invoices for, and CareOregon will not be obligated to pay, any amount in excess of the NTE compensation amount set forth above. If this NTE compensation amount is increased by amendment of this Contract, the amendment must be fully effective before Contractor performs Work subject to the amendment.

Invoices shall reference the above Contract Number and be submitted to:

covendorinvoices@careoregon.org.

5. Travel and Other Expense. Authorized: Yes No If travel expense reimbursement is authorized in this Contract, such expense shall only be reimbursed at the rates in the CareOregon Contractor Travel Reimbursement Allowance, hereby incorporated by reference and found at: https://www.careoregon.org/about-us/vendor-resources. Travel expense reimbursement is not in excess of the not to exceed compensation amount.

6. Contract Documents. This Contract consists of the following documents, which are listed in descending order of precedence and are attached and incorporated by reference, this Contract, Exhibit A (Scope of Work), Exhibit B (Add as applicable].

7. Contractor and CareOregon Contract Administrators.

Contractor Administrator:

Phone:

CareOregon Administrator:

Phone:

mailto:covendorinvoices@careoregon.org https://www.careoregon.org/about-us/vendor-resources

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Email:

Address:

Email:

ARTICLE II.

1. ACCESS TO RECORDS. During the term of the Contract and for a period of ten (10) years following the termination of the Contract, Contractor shall, upon written request, make available to any governmental agency, for CareOregon’s compliance with legal or regulatory requirements, all books and records of Contractor that are necessary to verify the nature and extent of the charges for the Work provided herein.

The provisions of this Section shall survive the termination of this Contract.

2. CAPTIONS. The captions or headings in this Contract are for convenience only and in no way define, limit, or describe the scope or intent of any provisions of this Contract.

3. COMPLIANCE WITH APPLICABLE LAW. Contractor shall, at all times during the term of this Contract and at Contractor’s own expense, comply with all applicable federal, state, and local laws, rules and regulations, and shall maintain in force any licenses and obtain applicable permits and consents required for performance of the Work under this Contract. Contractor shall provide copies of such applicable current valid licenses and/or permits upon request.

4. COUNTERPARTS. This Contract may be executed in several counterparts (electronic or otherwise), each of which shall be an original, all of which shall constitute the same instrument.

5. GOVERNING LAW AND DISPUTE RESOLUTION. This Contract, and all rights, obligations, and disputes arising out of it, shall be governed and construed in accordance with the laws of the State of Oregon without regard to principles of conflicts of law.

The Parties agree to negotiate to resolve any disputes in good faith and may use mediation services to facilitate a resolution. If the Parties are unable to resolve the dispute through negotiation or mediation, then upon written demand by either party, any dispute arising out of or in connection with this Contract, including any question regarding its existence, interpretation, validity, or termination, shall be referred to and definitively resolved by mandatory binding arbitration administered by the Judicial Arbitration and Mediation Services, Inc. (“JAMS”). The place of arbitration shall be Oregon. The arbitrator shall comply with the laws of Oregon. The judgment of the arbitrator shall be accompanied by a written statement of the basis for such judgment and may be entered and enforced by any court having proper jurisdiction. The award of the arbitrator shall be final and binding and shall not be subject to de novo judicial review. It is the express intent and understanding of the Parties that each shall be entitled to enforce its respective rights under any provision hereof through specific performance, in addition to recovering damages caused by a breach of any provision hereof, and to obtain any and all other equitable remedies as may be awarded by the arbitrator. Notwithstanding the above, each party shall have the right to seek provisional remedies from a court of competent jurisdiction. The provisions of this Section shall survive the termination of this Contract.

6. RESPONSIBILITY FOR DAMAGES; INDEMNITY. Each Party (“Indemnifying Party”) hereby agrees to defend, indemnify and hold harmless the other Party (“Indemnified Party”), its officers, directors, and employees from and against third party claims, loss, liability, expense (including reasonable attorneys’ fees), judgment or settlement contribution arising from injury to person or property, arising from any negligent act or omission on the part of Indemnifying Party’s officers, directors, or employees in connection with or arising out of: (a) Work performed under this Contract; (b) any breach or default in performance of any of Indemnifying Party’s obligations in this Contract including, without limitation, any breach of any warranty or representation. In the event that either Party, its officers, directors, or employees are made a party to any action or proceeding by reason of any matter for which the Indemnifying Party has hereby agreed to indemnify the Indemnified Party, then the Indemnifying Party, upon notice from Indemnified Party, shall

Management Services Page 15 defend such action or proceeding on behalf of Indemnified Party at the Indemnifying Party's sole cost and expense. Notwithstanding the foregoing, no defense or settlement shall be made without the prior written approval of the Indemnified Party, which shall not be unreasonably withheld. Each Party shall have the right to designate its own counsel if it reasonably believes the Indemnifying Party's counsel is not representing the Indemnified Party's best interest. This indemnity shall not be limited by reason of any insurance coverage required under this Contract and shall survive termination of this Contract.

7. INDEPENDENT CONTRACTOR STATUS. The service(s) to be rendered under this Contract are those of an independent contractor. Although CareOregon reserves the right to determine (and modify) the delivery schedule for the Work to be performed and to evaluate the quality of the completed performance, CareOregon cannot and will not control the means or manner of Contractor’s performance. Contractor is responsible for determining the appropriate means and manner of performing the Work. Contractor is not to be considered an agent or employee of CareOregon for any purpose, including, but not limited to the Contractor’s sole responsibility for payment of any Federal or State taxes required as a result of this Contract. This Contract is not intended to entitle the Contractor to any benefits generally granted to CareOregon employees, including, but not limited to, vacation, holiday and sick leave, other leaves with pay, tenure, medical and dental coverage, life and disability insurance, overtime, Social Security, Workers' Compensation, unemployment compensation, or retirement benefits.

8. INSURANCE. Contractor shall secure at its own expense and keep in effect during the term of the performance under this Contract the insurance required and minimum coverage indicated below. A checked box indicates the coverage is required. If the box is not checked, it is not required. The insurance requirements outlined below do not in any way limit the amount of scope of liability of Contractor under this Contract. Contractor shall provide proof of said insurance and name CareOregon as an additional insured on commercial general liability and business automobile liability policies. Contractor shall provide proof of insurance and shall provide CareOregon at least 30 days prior notice of any policy material change, lapse, or termination. Proof of insurance and any notification shall be emailed to: CareOregon Procurement Department at vendorservices@careoregon.org.

Required - Workers Compensation: Contractor shall comply with the statutory workers’ compensation requirements in ORS 656.017, unless exempt under ORS 656.027 or 656.126.

Required – Commercial General Liability: combined single limit, or the equivalent, of not less than $1,000,000 per occurrence, with an annual aggregate limit of $2,000,000 for Bodily Injury and Property Damage.

Required – Professional Liability: combined single limit, or the equivalent, of not less than $1,000,000 per claim, with an annual aggregate limit of $2,000,000 for damages caused by error, omission or negligent acts.

Required – Commercial Automobile Liability: combined single limit, or the equivalent, of not less than $1,000,000 per accident for Bodily Injury and Property Damage.

Required – Personal Automobile Liability: combined single limit, or the equivalent, of not less than $300,000 per accident for Bodily Injury and Property Damage.

Required – Abuse & Molestation endorsement with limits not less than $1,000,000 per…