RFP_2025-17_Health_Program_Consulting_Pool__FINAL.pdf

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 1

Request for Proposal

RFP 2025-17: Health Program Consulting Pool

June 12, 2026

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 2

TABLE OF CONTENTS

1. INTRODUCTION

1.1 Overview

1.2 Key Action Dates

1.3 Contact

1.4 Contract Term

1.5 Contract Amount

1.6 Contract Amendment

1.8 RFP Questions

1.9 Submission of Proposals

1.10 Format of Proposals

1.11 Covered California’s Rights

1.12 Rejection of Proposals

1.13 Errors in Proposals

1.14 Protest

1.15 Debrief Process

1.16 Disposition of Proposals

1.17 Contract Execution and Performance

1.18 Subsequent Solicitation

1.19 Addition or Subtraction of Services

1.20 News Releases and Social Media

2. PROJECT TEAM

2.1 Project Team Minimum Qualifications

2.2 Reassignment of Personnel

3. SCOPE OF WORK

3.1 Background

3.2 Purpose

3.3 Scope of Work

3.4 Contract Completion Criteria

3.5 Project Assumptions and Constraints

3.6 Payment and Invoicing

4. REQUIRED PROPOSAL SUBMISSION CONTENT

4.1 Proprietary Information and Confidential Status of Responses

4.2 Administrative Requirements

4.3 Technical Requirements

5. EVALUATION AND SELECTION FOR CONTRACT AWARD

5.1 Phase One: Administrative Requirements

5.2 Phase Two: Technical Requirements

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 3

6. PREFERENCE AND INCENTIVE PROGRAMS

6.1 How the Preferences and Incentives Work

6.2 Small Business Preference

6.3 Disabled Veteran Business Enterprise Incentive

6.4 Programs for Non-Small Businesses with Subcontractors

6.5 Target Area Contract Preference Act

7. ATTACHMENTS

8. MODEL CONTRACT WITH EXHIBITS

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1. INTRODUCTION

1.1 Overview

Potential Proposers are invited to review and respond to this Request for Proposal (RFP). By submitting a proposal, the Proposer organization agrees to the terms and conditions stated in this RFP.

Potential Proposers should carefully read this document and all attachments in their entirety, as they may contain binding provisions that affect the rights and obligations of Proposer organizations. Proposers must comply with the instructions contained in this document. Proposals for this RFP must be submitted to the Covered California contact designated in Section 1.3 below.

1.2 Key Action Dates

Proposers are advised of the key dates and times shown in the table below and are required to adhere to them. All times noted in this document are Pacific Time

(PT).

KEY ACTION DATES

Request for Proposal Release Date: June 12, 2026 RFP Questions Due Date and Time: June 22, 2026 by 2:00 PM Responses to Questions Posted By: July 06, 2026 Proposal Due Date and Time: July 27, 2026 by 2:00 PM Notice of Intent to Award: Week of August 17, 2026 Anticipated Contract Term: January 01, 2027 to December 31, 2029

1.3 Contact

For questions regarding this RFP, contact Covered California via email at HBEXSolicitation@covered.ca.gov with “RFP 2025-17” in the subject line. The Covered California contact for this solicitation is Joyce Anne Asper.

Please reference the RFP number in all communications. Phone calls will not be accepted.

1.4 Contract Term

The initial term of the contract shall be for three (3) years, from January 01, 2027 to December 31, 2029; however, the contract term is subject to change and may be amended. The resulting contract will be of no force or effect until signed by both parties. Performance shall not commence until a valid contract has been executed between the successful Proposer and Covered California. Covered California will not pay for any services performed prior to the execution of a valid contract.

mailto:HBEXSolicitation@covered.ca.gov

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1.5 Contract Amount

Covered California will award multiple contracts pursuant to this RFP. The total amount for the initial three-year term of all awarded contracts is $6,600,000. The total contract value will encompass all work performed under various contracts awarded as a result of this RFP in the Service Areas listed in Section 3.2. It is expected that the approved funding for the contract will not exceed $6,600,000 for the term of the contract, including any extensions of the term.

Funding is subject to annual budget approval by the Covered California Board of Directors. If full funding does not become available, Covered California may terminate or amend the contract to reflect reduced funding and reduced deliverables.

1.6 Contract Amendment

Covered California may, at its sole discretion, extend the term of the contract for two (2) additional consecutive years for the same services. The total number of contract years shall not exceed five (5) years.

Any amendment will require Covered California’s approval in accordance with its policies and procedures. An amendment may require a formal resolution from the Covered California Board of Directors before Covered California can execute it.

1.7 RFP Questions

Prospective Proposers must submit any questions regarding this RFP by the due date and time specified in the Key Action Dates table in Section 1.2. Only questions sent to the email address provided in Section 1.3 will be accepted.

Prospective Proposers must provide enough specific information to enable Covered California to identify and respond to their questions. When submitting questions, please reference the RFP number in the subject line.

Responses to questions received during the RFP Questions time period will be posted on the website at http://hbex.coveredca.com/solicitations. Proposers who fail to report a known or suspected problem with this RFP or who fail to seek clarification or correction of this RFP do so at their own risk.

In its sole discretion, Covered California may contact a prospective Proposer to seek clarification or additional information regarding any question received.

1.8 Submission of Proposals

1. Proposers’ Cost: Costs for developing proposals and attending Proposers’ Conferences are entirely and solely the responsibility of the Proposer and are not chargeable to Covered California.

http://hbex.coveredca.com/solicitations/

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2. Completion of Proposals: Proposers are required to be both responsive (fully compliant) and responsible (capable and qualified to perform work) relative to the solicitation requirements. Proposals must be complete in all respects and contain all required items as described in the requirements established within this RFP, its attachments, and any written responses to questions or amendments posted by Covered California on its website. A proposal may be rejected by Covered California, in its sole discretion, if the proposal is conditional, incomplete, or irregular in any way. A proposal must be rejected by Covered California if any defect or irregularity constitutes a material deviation from the RFP requirements as determined by Covered California, in its sole discretion.

3. False or Misleading Statements: Proposals which contain false or misleading statements, or which provide references that do not support an attribute or condition claimed by the Proposer may be rejected. If, in the sole opinion of Covered California, such information was intended to mislead Covered California in its evaluation of the proposal or was included as a result of gross negligence attributable to the Proposer, and the attribute, condition, or capability is a requirement of this RFP, it shall be grounds for rejection of the proposal.

4. Errors: If a Proposer discovers any ambiguity, conflict, discrepancy, omission, or other error in this RFP, the Proposer shall immediately notify Covered California of such error by emailing the contact in Section 1.3 and shall request a modification or clarification of the RFP. Modifications or clarifications will be given by written notice posted on the website at http://hbex.coveredca.com/solicitations without divulging the source of the request for modification or clarification. Covered California shall not be responsible for a Proposer’s failure to correct errors, nor for any Proposer’s failure to regularly and timely check the website for changes.

5. Importance of Meeting Deadlines: Proposers are responsible and assume all risks for the delivery and receipt by Covered California of all proposal submissions prior to the submission deadline. The stated deadlines for submitting a proposal and all required materials for receipt by Covered California will be strictly enforced. Submissions that are incomplete or received after the stated deadline may not be accepted.

6. Assessment of Proposals: All proposals will be assessed based on the evaluation criteria as set forth in this RFP and at Covered California’s sole discretion. The selection and contract award, if made, will be made to a single Proposer unless otherwise specified in this RFP. The Scope of Work (SOW) and the selected Proposer’s proposal, including proposed cost, will be incorporated by reference into the resulting contract.

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1.9 Format of Proposals

Proposers must submit a proposal package that contains all required attachments, documents, narrative responses, and Model Contract exhibits. Proposals must be submitted electronically via email to HBEXSolicitation@covered.ca.gov with “RFP 2025-17” in the subject line. Hard copy proposals will not be accepted and will be deemed non-responsive.

1. Electronic Signatures

Proposers may sign required attachments and documents electronically or with ink, so long as the attachments and documents are submitted in PDF format.

Signatures must be provided by an authorized signatory who is authorized to contractually bind the Proposer organization.

2. Narrative Format

a. Narrative portions of proposals should be prepared to provide a straightforward, concise delineation of the Proposer’s capabilities to satisfy the requirements of this RFP. Emphasis should be on conformance with the RFP instructions, responsiveness to the RFP requirements, and completeness and clarity of content. Expensive bindings, colored displays, promotional materials, etc., are not necessary nor desired.

b. Proposers must follow the format requirements listed below for all narrative portions of the proposal submission. Failure to do so may result in an entire proposal or affected section not being read or evaluated, at Covered California’s sole discretion.

1) Use a Times New Roman, Arial, or Calibri font of at least 12-point size throughout unless a form is required by Covered California that contains a smaller font.

2) Use one (1)-inch margins at the top, bottom, and sides.

3) Sequentially number the pages in each section and clearly identify each section in the order requested. When a page limit is noted, pages exceeding the limit will not be reviewed or scored. It is not necessary to paginate the required forms.

4) Place the Proposer organization’s name in a header or footer on every page. If the Proposer's name is not already entered elsewhere on a completed certification or form, add it to a header, footer, or signature block.

3. Model Contract with Exhibits

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All proposals must be based on and conform to the Model Contract provided with this solicitation. Proposers should review the Model Contract in its entirety prior to submitting a proposal. Proposers must submit as part of their proposals any changes or exceptions to the Model Contract that they wish to negotiate.

However, extensive or significant changes or exceptions to the Model Contract may make the proposal non-responsive to the RFP if Covered California, in its sole discretion, determines that the proposed changes or exceptions materially change the contractual relationship between the parties. Proposer-suggested changes or exceptions to the Model Contract exhibits must be documented via tracked changes to the documents using Microsoft® Word®. All Model Contract changes or exceptions must be included in the proposal package at the time of submission. No additional changes or exceptions may be presented during contract negotiations. Covered California reserves the right to reject all changes and exceptions in the proposal package.

1.10 Covered California’s Rights

1. Verification of Proposer Information

By submitting a proposal, the Proposer authorizes Covered California to do the following:

a. Verify any and all claims made by the Proposer, including, but not limited to, verification of prior experience and possession of all other required qualifications; and

b. Check any and all references identified by the Proposer, or any other resource known or identified by Covered California, to confirm the Proposer’s business integrity and history of providing effective, efficient, competent, and timely goods and/or services.

2. Covered California may, in its sole discretion, modify the RFP prior to the proposal submission deadline by the issuance of an addendum on the website listed at http://hbex.coveredca.com/solicitations.

3. Covered California reserves the right to reject any proposal that does not satisfy the requirements set forth in this RFP. Before submitting a response to this RFP, prospective Proposers should review and correct all errors and confirm compliance with all RFP requirements.

1.11 Rejection of Proposals

1. Deviations may cause a proposal to be deemed non-responsive and to not be considered for award. Covered California may reject any or all proposals and/or may waive any immaterial deviation or defect in a proposal. Covered California's waiver of any immaterial deviation or defect shall in no way modify the RFP documents or requirements and shall not excuse the Proposer from full compliance with the RFP specifications if awarded the contract.

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2. Proposals that are not received by the date and time specified in Section 1.2 Key Action Dates will be maintained separately from proposals that have been timely received. Proposals received after the due date may only be considered upon written approval of Covered California’s Executive Director or his/her designee specifying the reason(s) for acceptance and consideration of the untimely proposal.

3. Issuance of this RFP in no way constitutes a commitment by Covered California to award a contract. Covered California reserves the right to do the following:

a. Reject any or all proposals received in response to this RFP, or portions of proposals;

b. Amend or cancel this RFP at any time, after which Covered California may reissue the RFP at a later date; and

c. Consider a Proposer’s past contract performance with Covered California in its selection of a Proposer pursuant to this RFP.

4. Non-Responsive Proposals

A proposal may be deemed non-responsive and subsequently rejected if any of the following occur:

a. The proposal is received after the exact time and date set forth in Section

1.2 Key Action Dates for receipt of each submission;

b. The Proposer fails to meet one (1) or more of the minimum qualifications specified in Section 2, Project Team;

c. The Proposer fails to submit or fails to complete and sign any required attachments as instructed in this RFP;

d. The proposal contains false, inaccurate, or misleading statements or references;

e. The Proposer is unwilling or unable to fully comply with Covered California’s proposed contract provisions; or

f. The Proposer supplies conditional cost information, incomplete cost information, or cost information containing unsigned/uninitiated alterations or irregularities.

5. Business in Good Standing

Proposer acknowledges that when agreements are to be performed in the State of California by corporations or vendors, Covered California will verify, prior to

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 10 awarding any State contract, the following information in order to ensure that all obligations due to the State are fulfilled:

6. Corporation in Good Standing

As required by California law, Proposer organizations must be in good standing and qualified to do business in California at the time of submitting a proposal and, if selected by Covered California, during the entire term of the contract. If the Proposer organization is incorporated, the Proposer’s status with the California Secretary of State (SOS) must be Active; a status of Cancelled or Suspended will cause the Proposer to be deemed non-responsive. This requirement does not apply to sole proprietors and general partnerships.

Unless otherwise specified, the Proposer shall not submit copies of its organization’s bylaws or Articles of Incorporation.

“Doing business” is defined in California Revenue and Taxation Code section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the State not be subject to the franchise tax.

Both domestic and foreign (those incorporated outside of California) corporations must be in good standing in order to be qualified to do business in California.

7. State Tax Delinquency

a. Covered California will verify with the California Franchise Tax Board (FTB) and California Department of Tax and Fee Administration (CDTFA) that the Proposer is not on a prohibited list due to tax delinquencies. The proposal will be considered non-responsive if the Proposer is on any of these lists.

b. The list established by FTB can be found at: https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/corporate-income-tax-list.html.

c. The list established by CDTFA can be found at:

https://www.cdtfa.ca.gov/taxes-and-fees/top500.htm.

8. Executive Order N-6-22 – Russia Sanctions

On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding Economic Sanctions against Russia and Russian entities and individuals. “Economic Sanctions” refers to sanctions imposed by the U.S.

government in response to Russia’s actions in Ukraine, as well as any sanctions imposed under state law. By submitting a bid or proposal, Contractor represents that it is not a target of Economic Sanctions. Should Covered California determine Contractor is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned individuals or entities, that https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/corporate-income-tax-list.html https://www.ftb.ca.gov/about-ftb/newsroom/top-500-past-due-balances/corporate-income-tax-list.html https://www.cdtfa.ca.gov/taxes-and-fees/top500.htm

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 11 shall be grounds for rejection of the Contractor’s bid/proposal any time prior to contract execution, or, if determined after contract execution, shall be grounds for termination by Covered California.

1.12 Errors in Proposals

1. An error in a proposal may cause the rejection of that proposal; however, Covered California may, in its sole discretion, retain the proposal and make certain corrections. In determining if a correction will be made, Covered California will consider the conformance of the proposal to the format and content required by this RFP and any unusual complexity of the format and content required by this RFP.

a. If the Proposer's intent, as determined by Covered California, is clearly established based on its review of the complete proposal submission, Covered California may, in its sole discretion, correct an error based on that established intent.

b. Covered California may, in its sole discretion, correct obvious clerical errors.

c. A Proposer may modify a proposal after submission by withdrawing its original proposal and resubmitting a new one (1) as long as it is received prior to the proposal submission deadline. Modifications offered by a Proposer in any other manner, oral or written, will not be considered.

d. A Proposer may withdraw its proposal by submitting a written withdrawal request to Covered California, signed by the Proposer or an authorized agent. Proposals may not be withdrawn subsequent to the proposal submission deadline without cause.

e. No oral understanding or contract shall be binding on either party.

2. Covered California reserves the right to contact any Proposer at any stage of the solicitation process to collect additional clarifying information, if deemed necessary and appropriate by Covered California.

1.13 Protest

Any protest properly submitted within five (5) business days of the posting of the Notice of Intent to Award will be considered. All protests will be reviewed and decided by the Executive Director or his/her designee. The following protest procedures shall be followed:

1. General

An unsuccessful Proposer may protest the intended award to another Proposer by following the terms and conditions outlined below. The protester challenging Covered California’s intended award bears the burden of proof.

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2. Grounds

Protester must cite the specific grounds for the protest and provide all facts and citations of law sufficient to support the protest and enable the Executive Director or his/her designee to make an informed, proper decision. Covered California will determine, in its sole discretion, if the protester has demonstrated sufficient grounds to allow the protest to be heard. Abuse of the protest process by unsuccessful Proposers for the purpose of securing confidential information about other Proposers will be rejected by Covered California. The sole grounds for a protest are:

a. Protester reasonably believes that Covered California has acted in an arbitrary and capricious manner; and/or

b. Protester reasonably believes that Covered California committed an error in the proposal process as stated in the solicitation that is sufficiently material to justify invalidation of the intended award.

There shall be no basis for protest if Covered California rejects all proposals.

3. Requirements for Protest

Protests must be submitted in writing, signed by an individual who is authorized to contractually bind the Proposer, and include all grounds and supporting facts and evidence upon which the protest is based, as well as all citations of law, rule, regulation or procedure upon which the protester relies. Protests must be delivered to Covered California at the address indicated below by certified or registered mail or in person, in which case the protester should obtain a delivery receipt. Protests must be received by Covered California no later than the close of business five (5) business days after the Notice of Intent to Award has been posted.

Protests must be emailed to the email address shown in Section 1.3 above.

The Executive Director’s or his/her designee’s decision shall be final.

4. Terms of Protest

Scoring documents, evaluation and selection documents, other Proposers’ submissions, or any other record created during the review of proposals submitted in response to this RFP are not public records and are exempt from disclosure as public records pursuant to Government Code section 100508(a).

A protester who has demonstrated a legitimate ground for protest as described above may be provided limited access to certain relevant, non-public information regarding the RFP and Covered California’s consideration of submissions in response to the RFP upon the protester’s execution of a Non- Disclosure Agreement provided by Covered California and the approval of

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Covered California’s General Counsel or his/her designee. Trade secret, proprietary, and confidential information will be redacted from any documents disclosed to protester as part of the protest process.

1.14 Debrief Process

1. Once the contract has been awarded, any bidder can request a debrief of their bid by emailing the BSB contract analyst at HBEXSolicitation@covered.ca.gov.

Debriefs will be coordinated with bidders upon request up to 10 business days after the Notice of Intent to Award is released. If a request is received after this date, it will be declined.

2. The Contract Analyst will work with the Evaluation Team to determine which sections of the Evaluation and Selection Report (ESR) will be shared with the requested bidder.

3. A debrief will be presented via written letter, email, phone, or video call (i.e., Microsoft Teams, Zoom, etc.) at the discretion of the Contracts Unit.

4. Per Government Code Section 100508, the debrief will not include the deliberative processes, discussions, communications, any other portion of the negotiations, records that reveal claims data, encounter data, cost detail, information about payment methods, contracted rates paid by qualified health plans to providers, or enrollee coinsurance or other cost sharing that can be used to determine contracted rates paid by plans to providers.

1.15 Disposition of Proposals

Upon proposal opening, all documents submitted in response to this RFP become the property of the State of California.

1.16 Contract Execution and Performance

Performance shall begin no later than the date set forth in this RFP by Covered California and after the contract is fully executed, unless a later date is mutually agreed upon by Covered California and the Contractor. Notwithstanding any other provision, should the Contractor fail to commence work on the agreed date and time, Covered California reserves the right to terminate the contract upon five (5) business days written notice to the Contractor. In such an event, the Contractor shall be liable to Covered California for the difference between the Contractor’s cost proposal and, if greater, the actual cost of performing the work by a replacement contractor.

All performance under the contract shall be completed before the termination date of the contract, unless an earlier date is specified in the contract.

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1.17 Subsequent Solicitation

If at any time during the negotiation of a contract with the successful Proposer, Covered California determines it is not able to reach an agreement with the successful Proposer, Covered California may, in its sole discretion, terminate the negotiations and engage the next highest-scored Proposer without performing a subsequent solicitation.

1.18 Addition or Subtraction of Services

Notwithstanding that proposals have been submitted, at Covered California’s sole discretion, the SOW may be modified prior to contract award to add or remove services through an addendum. If the date and time for submission of proposals has passed as of the time the addendum is posted and proposals have been received, Covered California, in its sole discretion, may restrict responses to the modified SOW so that only entities that submitted timely proposals in response to the initial RFP may respond to the addendum.

1.19 News Releases and Social Media

By submitting a proposal, Proposers and the selected Contractor agree that they will not issue news releases nor make statements to the news media or through social media channels pertaining to this RFP, their proposals, the contract, or work resulting therefrom, without first obtaining prior approval from Covered California.

2. PROJECT TEAM

Covered California seeks a team with experience and knowledge of the process outlined in this RFP and the Model Contract Exhibit A – Scope of Work. Proposers must demonstrate that the project team members who will be assigned to the project possess the experience, education, knowledge, and skills required to perform the work described in this RFP.

2.1 Project Team Minimum Qualifications

The required minimum qualifications for Proposers include the following: All required minimum qualifications are outlined in Attachment 8 – Proposer Minimum Qualifications Certification. Please carefully review this Attachment to ensure that your organization meets the relevant minimum requirements for each Service Area being proposed before submitting a proposal. Failure to meet any minimum qualification will result in disqualification.

2.2 Reassignment of Personnel

1. The Contractor shall not reassign nor substitute personnel assigned to the contract during the contract term without prior written approval of Covered California. If a Contractor employee is unable to perform duties due to illness, RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 15 resignation, or other factors beyond the Contractor’s control, the Contractor shall make every reasonable effort to provide suitable substitute personnel.

2. Substitute personnel shall not automatically receive the hourly rate of the individual or position being replaced. Covered California and the Contractor shall negotiate the hourly rate of any substitute personnel to the contract. The hourly rate negotiated shall be dependent, in part, on the experience and individual skills of the proposed substitute personnel; however, the negotiated rate shall not exceed the hourly rate stated in the contract.

3. Covered California reserves the right to require a Contractor employee to be removed from performing any work on the contract and on written notice to the Contactor, the Contractor shall assign an acceptable substitute employee.

3. SCOPE OF WORK

3.1 Background

1. Soon after the passage of national health care reform through the Patient Protection and Affordable Care Act of 2010 (ACA), California became the first state to enact legislation to establish a qualified health benefit exchange. The California state law is referred to as the California Patient Protection and Affordable Care Act (CA-ACA).

2. The goals and objectives of Covered California are to:

a. Reduce the number of uninsured Californians by creating an organized, transparent marketplace for Californians to purchase affordable, quality health care coverage to claim available federal tax credits and cost-sharing subsidies, and to meet the personal responsibility requirements imposed under the federal act (ACA);

b. Strengthen the health care delivery system;

c. Serve as an active purchaser, including creating competitive processes to select participating carriers and other contractors;

d. Require that health care service plans and health insurers issue coverage in the individual and small employer markets and compete on the basis of price, quality, and service (and not on risk selection); and

e. Meet federal and state law requirements, guidance and regulations.

3. Covered California is an independent public entity within California State Government. It is governed by a five (5)-member board appointed by the Governor and Legislature.

4. Covered California works in close partnership with:

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a. The Department of Health Care Services, which oversees and administers California’s Medicaid Program (Medi-Cal) and other specifically-focused health programs;

b. The two (2) agencies that regulate health insurance in California, the Department of Managed Health Care and the Department of Insurance;

and

c. A broad range of stakeholders whose constituencies may be impacted by health care reform.

5. For additional information on Covered California, please refer to the consumer website at www.CoveredCA.com and the business website at hbex.CoveredCA.com.

3.2 Purpose

The purpose of this RFP is for Covered California to solicit proposals from qualified Proposers in order to establish a pre-approved contractor pool of qualified organizations and/or individuals with various specialized areas of expertise from which Covered California will contract with for various projects. These contractors will be here forward be identified as the “health program consulting pool.” Covered California will utilize the health program consulting pool to meet changing needs for a broad range of research objectives and goals.

Covered California must continually assess its program’s strategic direction and make informed decisions within the healthcare marketplace. The health program consulting pool is expected to provide expertise and experience which will help the agency successfully navigate the ever-changing healthcare marketplace, as well as any changes to the Affordable Care Act (ACA). The health program consulting pool will also add a breadth of national healthcare knowledge that will complement Covered California’s staff’s expertise

The health program consulting pool will consist of contractors who can provide specialized services in one (1) or any combination of the six (6) following Service Areas:

• Service Area 1: Health Program Actuarial Services

• Service Area 2: Health Benefits Consulting Services

• Service Area 3: Pharmaceutical Benefits Consulting Services

• Service Area 4: Dental Benefits Consulting Services

• Service Area 5: Healthcare Marketplace Development Consulting Services

• Service Area 6: Health Equity and Quality Transformation Consulting Services

Covered California will utilize the health program consulting pool to perform special projects. When a project need arises, one or more contractors within the pool may be asked to prepare a proposal describing: their understanding of the project; their approach to addressing the scope of responsibilities and activities; how the http://www.coveredca.com/ https://hbex.coveredca.com/

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 17 contractor will provide the flexibility to address issues as they arise while maintaining a high level of quality; relevant experience or expertise; staff that would be assigned to the project; and the fee the contractor would charge for completion of the work. Covered California will review all requested work proposals submitted and choose a contractor in the health program consulting pool based on required expertise, proposed approach, ability to meet proposed timelines, and cost for the work. A Work Order (Attachment 1 to Exhibit A – Sample Work Order) will formalize the terms and conditions of each project assignment.

Please note, Covered California may select more than one contractor for each Service Area to participate in the health program consulting pool.

If a contractor is selected to be in the health program consulting pool for one (1) or more Service Area, the Scope of Work (SOW) in the Model Contract Exhibit A will be adjusted to only include the Service Areas each successful proposer was awarded to provide.

3.3 Scope of Work

See Model Contract Exhibit A – Scope of Work for a detailed description of the services and work to be performed by the successful Proposer.

3.4 Contract Completion Criteria

The contract resulting from this RFP will be considered complete when Covered California has approved and accepted all assigned contract deliverables.

3.5 Project Assumptions and Constraints

1. The Contractor’s work hours shall be consistent with Covered California’s key staff on-site, whose normal business hours are 8:00 AM to 5:00 PM, Monday through Friday, except for State holidays.

2. Overtime rates will not be reimbursed under the contract.

3. Travel will not be reimbursed under the contract.

4. Any modifications to tasks within Exhibit A – Scope of Work of the contract shall be defined, documented, and mutually agreed upon by the Contractor and Covered California’s representative prior to starting work on the modified task(s). Covered California’s representative may refine or clarify the services deemed necessary to meet the needs of this project in accordance with Covered California’s priorities.

5. Covered California and the Contractor shall be mutually obligated to keep open and regular channels of communication in order to ensure the successful performance of the contract. Both parties shall be responsible for communicating potential problems or issues to Covered California’s

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Representative and the Contractor’s project team manager, respectively, within forty-eight (48) hours of becoming aware of the problem or issue.

3.6 Payment and Invoicing

If the collection of fees assessed from QHPs are collectively not sufficient to provide the funds for this program, Covered California shall have the option to either cancel this contract with no liability occurring to Covered California or offer a contract amendment to the Contractor to reflect the reduced amount.

The Contractor may invoice Covered California only after the successful completion and acceptance of the contract deliverables. The Contractor may not invoice Covered California for any costs exceeding the maximum amount identified to complete a deliverable.

4. REQUIRED PROPOSAL SUBMISSION CONTENT

Proposal submissions must include content for the following categories, which are described in detail in the sections below.

1. Administrative Requirements

a. Required attachments

b. Required documents

c. Updated Model Contract with Exhibits

2. Technical Requirements

a. Understanding and Approach

b. Corporate Qualifications Summary

c. Project Team Qualifications

i. Resumes

d. Project Assumptions

e. Cost Proposal

4.1 Proprietary Information and Confidential Status of Responses

Any documentation submitted which has been marked “Proprietary” or “Trade Secrets” may be rejected. All proposals and evaluation documents are confidential and will not be available for public inspection pursuant to Government Code Section 100508(a)(1).

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4.2 Administrative Requirements

To be deemed responsive, Proposers must comply with the Administrative Requirements in this section.

4.2.1 Required Attachments

1. Proposals must include the following required attachments as set forth below. Any attachment that requires a signature must be signed by a representative authorized to contractually bind the Proposer organization. Photocopies of wet signatures and electronic signatures are acceptable.

a. The Proposal Cover Page form (Attachment 1) completed and signed;

b. The Payee Data Record (STD. 204) form (Attachment 2) completed and signed;

c. The Contractor Certification Form (Attachment 3) completed and signed;

d. The Statement of Economic Interests Certification form (Attachment

4) completed and signed;

e. The Bidder Declaration (GSPD-05-105) form (Attachment 5) completed and signed;

f. The Proposal Checklist (Attachment 6) completed; and

g. The Generative Artificial Intelligence Risk Assessment (HBEX 707) (Attachment 7) completed.

h. Proposer’s Minimum Qualifications Certification form (Attachment 8) completed and signed.

2. Attachment 4 is a Proposer certification form whereby the Proposer acknowledges and agrees that, upon contract execution, the Proposer’s representative and applicable staff, if identified as code filers, agree to provide a completed Statement of Economic Interests (Form 700). For more information, see the Covered California Conflict of Interest Code at http://hbex.coveredca.com/resources and the Fair Political Practices Commission website at http://www.fppc.ca.gov/Form700.html.

3. Attachment 8 is a Proposer minimum qualifications certification form.

Proposers must complete Attachment 8 for each Service Area they are proposing to provide. Proposers that fail to comply with any of the http://hbex.coveredca.com/resources http://www.fppc.ca.gov/Form700.html

RFP 2025-17: Health Program Consulting Pool (V.05.28.2025) Page 20

Certification’s terms may result in disqualification from participation in this RFP solicitation process.

4. If the Proposer wishes to claim the DVBE incentive and/or the SB preference (see Section 6, Preference and Incentive Programs), the following optional attachments must also be included, as applicable:

a. The Disabled Veteran Business Enterprise Declarations (STD. 843) form (Attachment 9) completed and signed;

4.2.2 Required Documents

1. Proposals must include the following required insurance documents:

a. A Certificate of Liability Insurance equal to or greater than $1,000,000.00;

b. Proof of Workers’ Compensation Liability Insurance;

c. Proof of Cyber Liability Insurance;

d. Proof of Automobile Liability Insurance, including non-owned auto liability, of $1,000,000.00 per occurrence for persons used by the Contractor for services provided pursuant to this contract; and

e. Proof of Professional Liability Insurance.

2. If the Proposer cannot include a Certificate of Liability Insurance and/or a Certificate of Automobile Liability Insurance and/or Proof of Professional Liability Insurance with its proposal, it must provide a written explanation detailing why it cannot comply with the requirement(s). Covered California may, in its sole discretion, accept a proposal without these Certificates if the Proposer provides a valid justification for the absence of one (1) or more of them and confirms that it will submit the appropriate Certificate(s) prior to contract execution, if it is selected as the Contractor. Covered California cannot execute a contract with the selected Contractor without these required Certificates and will award the contract to the next highest-scored Proposer if the Contractor fails to produce the Certificate(s) prior to contact execution.

3. If the Proposer organization is incorporated, proof of Active status with the California SOS must be provided in one (1) of the following forms:

a. A copy of the Proposer’s current Certificate of Status issued by the SOS; or

b. A copy of the Proposer’s Entity Detail page from the SOS’s Business Search website (https://bizfileonline.sos.ca.gov/search/business) .

https://bizfileonline.sos.ca.gov/search/business

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4.2.3 Updated Model Contract with Exhibits

1. Proposers must make any suggested changes to the Model Contract as instructed below.

a. Using the Model Contract Exhibit A – Scope of Work provided, include a revised Exhibit A – Scope of Work with suggested tracked changes in Microsoft® Word®.

b. Using the Model Contract Exhibit B – Budget Detail and Payment Provisions and Exhibit B, Attachment 1 – Cost Worksheet provided, include a revised Exhibit B – Budget Detail and Payment Provisions with suggested tracked changes in Microsoft® Word®.

c. Using the Model Contract Exhibit C – General Terms and Conditions provided, include a revised Exhibit C – General Terms and Conditions with suggested tracked changes in Microsoft® Word®.

2. Submission of Model Contract exhibits without suggested tracked changes will constitute acceptance by the Proposer of the exhibits as drafted.

4.2.4 Generative Artificial Intelligence (GenAI)

Covered California seeks to realize the potential benefits of GenAI, through the development and deployment of GenAI tools, while balancing the risks of these new technologies.

Proposer must notify the State in writing if their solution or service includes, or makes available, any GenAI including GenAI from third parties or subcontractors.

Failure to submit the Generative Artificial Intelligence Risk Assessment (HBEX 707) will result in disqualification of the Proposer.

Failure to report GenAI to Covered California may void any resulting contract. Covered California reserves its right to seek any and all relief it may be entitled to as a result of such non-disclosure.

Upon receipt of a Proposer’s Generative Artificial Intelligence Risk Assessment (HBEX 707), Covered California reserves the right to incorporate GenAI Special Provisions into the final contract or reject bids/offers that present an unacceptable level of risks.

4.3 Technical Requirements

To be deemed responsive and responsible, Proposers must comply with the Technical Requirements in this section.

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4.3.1 Understanding and Approach

Proposers must provide a narrative description of their understanding of the project's goals, emphasizing their understanding of the objectives and the major activities that must be performed to complete the work. Proposers should discuss their strategy for providing the services outlined in the SOW.

Proposers should also include their expectations of all entities outside their own project team, if any, and provide any assumptions used to develop the response.

(No more than four (4) pages.)

4.3.2 Corporate/Organization Qualifications Summary

1. Proposers should describe their specific knowledge, experience, and qualifications based on the instructions and needs of each Service Area.

Requirements vary for different Service Areas. Proposers only need to complete the narrative for Service Areas for which they are proposing to provide.

2. For each of the six Service Areas that the Proposer seeks to provide services, Proposers must narratively describe their overall capability and available resources and provide specific examples, as these factors relate to the general requirements set forth in Model Contract Exhibit A – Scope of Work. The narrative must provide sufficient detail to demonstrate the Proposer’s ability to perform specialized evaluation needs as described in this RFP. Proposer must provide sufficient documentation to demonstrate how it meets all of the minimum qualifications for each Service Area category for which it wishes to be considered. Proposer must include a summary of relevant background information to demonstrate that they meet the minimum qualifications certified in the Attachment 8 – Proposer’s Minimum Qualifications Certification and address all of the following:

a. Ability to manage projects similar to those described in Exhibit A - Scope of Work for each Service Area and the risks involved;

b. Ability to complete projects on time and within budget;

c. Ability to provide quality deliverables; and

d. Evidence of experience performing the services outlined in the Service Area categories for which Proposer is applying, including the total number of years the Proposer has been providing these services.

(No more than six (6) pages.)

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4.3.3 Project Team Qualifications

Covered California seeks a team of highly-qualified senior staff to provide high-level support services as required by the Model Contract. Technical and skill-based staff may also be necessary to fulfill the Scope of Work.

Please carefully review Exhibit A for any requirements related to the project team and staffing.

Proposers must narratively describe the qualifications of each member of the proposed project team and identify the role each member is expected to have, including the experience, education, knowledge, and skills each possesses as they relate to the proposed role. Qualifications that are most relevant to this RFP and the proposed Service Areas must be highlighted. In addition, Proposers must identify the key staff that will be the points of contact for Covered California.

(No more than four (4) pages.)

4.3.3.1 Resumes

1. Proposers must provide a resume of the relevant experience held by each proposed project team member. For each experience cited on a resume, the information must include the following:

a. The total duration (i.e., the start month and year, the end month and year, and the total number of years and months);

and

b. A description of specific experience (i.e., a complete description of the relevant experience, including identification of the client, name of the project, roles and responsibilities of the individual, and types of services provided by the individual).

2. When preparing resumes for submission, Proposers should only include the individual work experiences that are most relevant to this RFP. Work experiences that are not relevant to this RFP will not be considered by Covered California in determining whether the Proposer is responsible.

4.3.4 Client References

Proposers must submit Client References and must list clients served in the past three years for which Proposer provided services similar to those listed in in the Model Contract Exhibit A - Scope of Work.

(No more than four (4) pages.)

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4.3.5 Project Assumptions

Proposers must document any assumptions they are making about the SOW, the responsibilities of the Contractor and Covered California, and any other issues relevant to proposal submission in response to this RFP and the ability to do the work for the proposed cost.

(No more than four (4) pages.)

4.3.6 Cost Proposal

Proposers must submit one (1) detailed Exhibit B, Attachment 1 – Cost Worksheet to be used for the duration of the contract unless otherwise mutually agreed upon in writing.

Exhibit B, Attachment 1 – Cost Worksheet must include the following:

Please identify the key positions with descriptions and fully loaded hourly rates for each Service Area the proposer is interested in providing. Please add additional rows as needed for each position. Fully loaded hourly rates should include indirect costs (fringe, overhead, general and administrative (G&A) expenses) and any profits or fees. This list will be incorporated verbatim into the contract.

1. Contractor will provide a written cost estimate bid (work order pursuant to Exhibit A, Section J) with specification detail for each requested project.

Contractor may only commence work once Covered California has executed a work order.

2. In order to be considered and fairly evaluated, Contractor must have competitive pricing on all projects.

The Cost Proposal must be submitted in Exhibit B, Attachment 1 – Cost Worksheet.

4.4 Submission Format Instructions

Narrative portions of the technical proposal responses should be prepared in such a way as to provide a straightforward and concise delineation of capabilities to satisfy the requirements of this RFP. Emphasis should be placed on conformance to the RFP instructions, responsiveness to the RFP requirements, completeness, and clarity of content.

Proposals for one (1) or any combination of the six (6) following Service Areas should be organized in the same order as below:

• Service Area 1: Health Program Actuarial Services

RFP 2025-17: Health…