RFP 2025HCA5 Attachment 1_APM Framework_RFP.pdf

This is a Request for Proposals (RFP) document from the Washington State Health Care Authority (HCA) for fully-insured medical plans. The RFP seeks proposals from bidders to provide up to three fully-insured health plans that meet the requirements outlined in the draft contract and Statement of Work. The document includes an attachment detailing the Updated Alternative Payment Model (APM) Framework, which establishes the structure for payments from public and private payers to provider organizations. This framework is designed to accommodate multiple payment categories from single payers and to classify payments across a continuum of clinical and financial risk for provider organizations, including payments between integrated health system components.

The APM Framework document serves as a foundational reference for understanding the payment mechanisms and risk arrangements that bidders must incorporate into their proposed health plans. The framework accommodates the complexity of modern healthcare payment structures by allowing for discrete payment categories while capturing the full spectrum of financial risk distribution between payers and providers. Specific details regarding pricing terms, set-asides, response deadlines, site visit requirements, bidders' conferences, award dates, and contract terms should be referenced in the complete RFP documentation and exhibits, particularly Exhibit B and Attachment 3 Statement of Work.