RFP 27 054 Medicaid Administrative Claiming Support-RFP 27 054 Medicaid Administrative Claiming Support.pdf

State of Hawaii Department of Health

Executive Office on Aging

Request for Proposals Solicitation #RFP-27-054

Medicaid Administrative Claiming Support

OFFERS ARE DUE AT 2:00 P.M., HAWAII STANDARD TIME (HST) ON

Monday, August 10, 2026

(or such later date as may be established by the State of Hawaii by an Addendum to this RFP)

BY SUBMISSION THROUGH THE HAWAIʻI ELECTRONIC PROCUREMENT SYSTEM

(HIEPRO)

DIRECT ALL QUESTIONS REGARDING THIS RFP, QUESTIONS OR ISSUES RELATING

TO THE ACCESSIBILITY OF THIS RFP (INCLUDING THE ATTACHMENTS AND

EXHIBITS AND ANY OTHER DOCUMENT RELATED TO THIS RFP) AND REQUESTS

FOR ACCOMMODATIONS FOR PERSONS WITH DISABILITIES IN CONNECTION

WITH THIS RFP, TO:

CANDICE BRYANT

PROGRAM AND SYSTEMS MANAGEMENT SUPERVISOR

EXECUTIVE OFFICE ON AGING

250 SOUTH HOTEL STREET, SUITE 406

HONOLULU, HI 96813

(808) 586-7297

CANDICE.BRYANT@DOH.HAWAII.GOV

Note: It is the Offeror’s responsibility to check the public procurement notice website, the request for proposals website, or to contact the RFP point-of-contact identified in the RFP for any addenda issued to this RFP.

The State shall not be responsible for any incomplete proposal submitted as a result of missing addenda, attachments or other information regarding the

RFP.

July 9, 2026

REQUEST FOR PROPOSALS

Medicaid Administrative Claiming Support RFP No. 27-054

The Department of Health, Executive Office on Aging (“EOA”) seeks a qualified Contractor to provide technical, administrative, and operational support for Hawaiʻi’s Medicaid Administrative Claiming program. The Contractor shall operate and maintain a federally compliant Random Moment Sampling (“RMS”) system, support claim development and calculation activities, provide training and technical assistance to participating agencies, and assist EOA in preparing quarterly Medicaid Administrative Claims.

The Contractor shall provide a secure, web-based solution that supports RMS administration, reporting, claim calculation, documentation, and ongoing program management.

The anticipated contract term shall be for two (2) years, from September 1, 2026 through August 31, 2028, unless otherwise specified in the executed contract or Notice to Proceed.

The EOA will conduct an orientation meeting to discuss the scope of work, and the required contractor qualifications on July 20, 2026, 11:00 AM Hawaii Standard Time (hereinafter “HST”). The orientation will be conducted remotely via Microsoft Teams.

Microsoft Teams Meeting Information:

Meeting Link: Medicaid Administrative Claiming Support RFP Orientation Meeting ID: 291 642 712 375 592 Passcode: 3ad78WX9

The EOA will be accepting questions regarding this RFP, up to July 24, 2026, 2:00 PM HST at EOA, 250 S. Hotel Street, Suite 406, Honolulu, Hawaii 96813 or by e-mail at Candice.bryant@doh.hawaii.gov. All written questions will receive a written response from the Executive Office on Aging by July 28, 2026.

Responses to this request for proposals shall be submitted by no later than 2:00 PM HST on August 10, 2026.

The DOH/EOA reserves the right to reject any and all proposals and to accept any proposal in whole or in part when in the best interest of the EOA and the State.

Any inquiries and requests regarding this RFP should be directed to Candice Bryant at

(808) 586-7297 or via email at Candice.bryant@doh.hawaii.gov https://teams.microsoft.com/meet/291642712375592?p=5lwQMLU8XNR15Sg41Z

Table of Contents

Section 1 Administrative Overview

1.1 Procurement Timetable

1.2 Website Reference

1.3 Authority

1.4 RFP Organization

1.5 Contracting Office

1.6 Contract Type

1.7 Period of Performance

1.8 RFP Point-of-Contact

1.9 Orientation

1.10 Submission of Questions

1.11 Submission of Proposals

1.12 Discussions

1.13 Additional Materials and Documentation

1.14 RFP Amendments

1.15 Best and Final Offer

1.16 Cancellation of Request for Proposals

1.17 Costs for Proposal Preparation

1.18 Rejection of Proposals

1.19 Notice of Award

1.20 Debriefing

1.21 Protests

1.22 Availability of Funds

1.23 General and Special Conditions of the Contract

1.24 Cost Principles

1.25 Contract Execution

Section 2 - Service Specifications

2.1. Introduction

A. Background B. Description of the Service Goals

2.2. Contract Monitoring and Evaluation

2.3. General Requirements

2.4. Scope of Work

Section 3 - Proposal Instructions

General Instructions for Preparing Proposals

3.1. Proposal Identification Form

3.2. Proposal Offer Form

3.3. Table of Contents

3.4. Program Overview

3.5. Organizational Experience and Capability

3.6. Understanding of Project Requirements and Proposed Approach

3.7. Work Plan and Service Delivery

3.8. Staffing and Organizational Structure

3.9. Data Management, Reporting, and Quality Assurance

3.10. Cost Proposal and Budget Narrative

3.11. Other and Attachments

A. Litigation

Section 4 – Proposal Evaluation

4.1. Introduction

4.2. Evaluation Process

4.3. Evaluation Criteria

A. Phase 1 – Evaluation of Proposal Requirements B. Phase 2 – Evaluation of Proposal C. Phase 3 – Recommendation for Award

Section 5 – Attachments

A. Proposal Identification Form (OF-1) B. Proposal Offer Form (OF-2) C. Sample Table of Contents D. General Conditions

Section 1

Administrative Overview

Section 1 Administrative Overview

Offerors are encouraged to read each section of the RFP thoroughly. While sections such as the administrative overview may appear similar among RFPs, State purchasing agencies may add additional information as applicable. It is the responsibility of the Offeror to understand the requirements of each RFP.

1.1 Procurement Timetable

Note that the procurement timetable represents the State’s best estimated schedule.

If an activity on this schedule is delayed, the rest of the schedule will likely be shifted by the same number of days. Contract start dates may be subject to the issuance of a Notice to Proceed.

Event Date

Solicitation Release: July 9, 2026

Pre-Proposal Orientation: July 20, 2026, 11:00 AM HST

Question Submittal Deadline: July 24, 2026, 2:00 PM HST

Answers to Questions: July 28, 2026

Proposal Due Date and Time: August 10, 2026, 2:00 PM HST

Evaluations August 11–14, 2026

Estimated Date for Discussions, if necessary TBD

Estimated Due Date for BAFO, if necessary TBD

Anticipated Award Date: August 19, 2026

Contract start date September 1, 2026

1.2 Website Reference

Item Website

Procurement of Goods, Services, & Construction https://spo.hawaii.gov/for-vendors/vendor-guide/methods-of-procurement/goods-services-construction/competitive-sealed-proposals-procurement-method/

2 RFP website https://hiepro.ehawaii.gov/welcome.html?redirectContext=welcome.html

Hawaii Revised Statutes (HRS) and Hawaii Administrative Rules (HAR) for Competitive Sealed Proposals https://www.capitol.hawaii.gov/hrscurrent/Vol02_Ch0046 -0115/hrs0103D/HRS_0103D-.htm;

https://spo.hawaii.gov/references/har/goods/

4 General Conditions, AG- 103D https://hiepro.ehawaii.gov/static-resources/AG- 008%20103D%20General%20Conditions%20(1.10.23).pdf

5 Forms https://spo.hawaii.gov/all-forms/

6 Cost Principles http://spo.hawaii.gov Search: Keywords “Cost Principles”

7 Protest Forms/Procedures https://spo.hawaii.gov/for-vendors/vendor-guide/protests-for-goods-services-construction/

8 Hawaii Compliance Express (HCE) http://spo.hawaii.gov/hce/

9 Hawaii Revised Statutes http://capitol.hawaii.gov/hrscurrent

10 Department of Taxation http://tax.hawaii.gov

11 Department of Labor and Industrial Relations http://labor.hawaii.gov

Department of Commerce and Consumer Affairs, Business Registration https://cca.hawaii.gov/breg/

13 Campaign Spending Commission http://ags.hawaii.gov/campaign/

14 Internal Revenue Service http://www.irs.gov/

(Please note: website addresses may change from time to time. If a State link is not active, try the State of Hawaii website at http://hawaii.gov)

1.3 Authority

This RFP is issued under the provisions of the Hawaii Revised Statutes (“HRS”) Chapter 103D and its administrative rules, Hawaii Administrative Rules (“HAR”) Chapters 3-120 https://spo.hawaii.gov/for-vendors/vendor-guide/methods-of-https://spo.hawaii.gov/for-vendors/vendor-guide/methods-of-https://hiepro.ehawaii.gov/welcome.html?redirectContext=welcome.html https://www.capitol.hawaii.gov/hrscurrent/Vol02_Ch0046-0115/hrs0103D/HRS_0103D-.htm https://www.capitol.hawaii.gov/hrscurrent/Vol02_Ch0046-0115/hrs0103D/HRS_0103D-.htm https://www.capitol.hawaii.gov/hrscurrent/Vol02_Ch0046-0115/hrs0103D/HRS_0103D-.htm https://spo.hawaii.gov/references/har/goods/ https://hiepro.ehawaii.gov/static-resources/AG-008%20103D%20General%20Conditions%20(1.10.23).pdf https://hiepro.ehawaii.gov/static-resources/AG-008%20103D%20General%20Conditions%20(1.10.23).pdf https://spo.hawaii.gov/all-forms/ http://spo.hawaii.gov/ https://spo.hawaii.gov/for-vendors/vendor-guide/protests-for-goods-https://spo.hawaii.gov/for-vendors/vendor-guide/protests-for-goods-http://spo.hawaii.gov/hce/ http://capitol.hawaii.gov/hrscurrent http://tax.hawaii.gov/ http://labor.hawaii.gov/ https://cca.hawaii.gov/breg/ http://ags.hawaii.gov/campaign/ http://www.irs.gov/ http://hawaii.gov/ to 3-132. All prospective Offerors are charged with presumptive knowledge of all requirements of the cited authorities. Submission of a valid, executed proposal by any prospective Offeror shall constitute admission of such knowledge on the part of such prospective Offeror.

1.4 RFP Organization

This RFP is organized into five sections:

Section 1, Administrative Overview: Provides Offerors with an overview of the procurement process.

Section 2, Service Specifications: Provides Offerors with a general description of the tasks to be performed, delineates contractor responsibilities, and defines deliverables (as applicable).

Section 3, Proposal Instructions: Describes the required format and content for the proposal.

Section 4, Proposal Evaluation: Describes how proposals will be evaluated by the State purchasing agency.

Section 5, Attachments: Provides Offerors with information and forms necessary to complete the proposal.

1.5 Contracting Office

The Contracting Office is responsible for overseeing the contract(s) resulting from this RFP, including system operations and monitoring and assessing Contractor performance.

The Contracting Office is:

Department of Health, Executive Office on Aging 250 S. Hotel St. Suite 406 Honolulu, HI 96813 Ph: (808) 586-0100; Fax: (808) 586-0185

1.6 Contract Type

The resulting contract shall be a cost-reimbursement contract. The Contractor shall be reimbursed for allowable costs actually incurred in the performance of the contract, subject to the approved budget, availability of funds, and the maximum compensation established in the contract.

All costs shall comply with applicable State cost principles under HAR Chapter 3-123 and applicable federal cost principles.

The maximum compensation available under this procurement for the initial two-year contract term is $350,000.00.

For proposal purposes, Offerors shall submit separate budgets for Contract Year 1 and Contract Year 2. The State anticipates funding of approximately $210,000 for Contract Year 1 and approximately $140,000 for Contract Year 2 to reflect the higher level of implementation activities anticipated during the first year of the contract. These annual funding amounts are planning estimates for proposal evaluation purposes and do not establish separate contractual funding limits.

1.7 Period of Performance

This contract shall be for a period of two (2) years beginning on the date specified on the Notice to Proceed or executed contract. Unless terminated, the contract may be extended without re-solicitation, upon mutual agreement in writing between the State and the Contractor, prior to the expiration date, for not more than four (4) additional 12-month periods, or parts thereof.

1.8 RFP Point-of-Contact

From the release date of this RFP until the selection of the successful offeror, any inquiries and requests shall be directed to the sole point-of-contact identified below.

Candice Bryant Department of Health, Executive Office on Aging 250 S. Hotel St. Suite 406 Honolulu, HI 96813

(808) 586-7297 Candice.bryant@doh.hawaii.gov

1.9 Orientation

An orientation for Offerors in reference to the request for proposals will be held as follows:

Date: July 20, 2026 Time: 11:00 AM HST

Location:

Microsoft Teams Meeting Information:

Meeting Link: Medicaid Administrative Claiming Support RFP Orientation Meeting ID: 291 642 712 375 592 Passcode: 3ad78WX9

Offerors are encouraged to submit written questions prior to the orientation. Impromptu questions will be permitted at the orientation and spontaneous answers provided at the State purchasing agency's discretion. However, answers provided at the orientation are only intended as general direction and may not represent the State purchasing agency's position. Formal official responses will be provided in writing. To ensure a written response, any oral questions should be submitted in writing following the close of the orientation, but no later than the submittal deadline for written questions indicated in the subsection 1.10, Submission of Questions.

1.10 Submission of Questions

Offerors may submit questions to the RFP point-of-contact identified in Section 1.8.

Written questions should be received by the date and time specified in Section 1.1 Procurement Timetable. The purchasing agency will respond to written questions by way of an addendum to the RFP.

Deadline for submission of written questions:

Date: July 24, 2026 Time: 2:00 PM HST

State agency responses to Offeror written questions will be provided by:

Date: July 28, 2026

1.11 Submission of Proposals

A. Forms/Formats - Forms, except for program specific requirements, may be found on the State Procurement Office website referred to in Section 1.2, Website Reference.

1. Proposal Identification Form (Form OF-1). Provides Offeror proposal identification. Form OF-1 is attached hereto as Attachment A.

2. Table of Contents. A sample table of contents for proposals is located in Section 5, Attachments. This is a sample and meant as a guide.

3. Proposal Offer Form (Form OF-2). The Offeror shall complete and submit Form OF-2, attached hereto as Attachment B, as part of its proposal. The Offeror's detailed Cost Proposal and Budget Narrative shall be submitted in accordance with Section 3.10 of this RFP.

B. Program Specific Requirements. Program specific requirements are included in Sections 2 and 3, as applicable.

C. Multiple or Alternate Proposals. Multiple or alternate proposals shall not be accepted unless specifically provided for in Section 2. In the event alternate proposals are not accepted and an Offeror submits alternate proposals, but clearly indicates a primary proposal, it shall be considered for award as though it were the only proposal submitted by the Offeror.

D. Offeror Compliance. All Offerors shall comply with all laws governing entities doing business in the State.

• Tax Clearance. Pursuant to HRS §103-53, as a prerequisite to entering into contracts of $25,000 or more, Offerors are required to have a tax clearance from the Hawaii State Department of Taxation (DOTAX) and the Internal Revenue Service (IRS). Refer to Section 1.2, Website Reference for DOTAX and IRS website address.

• Labor Law Compliance. Pursuant to HRS §103-55, Offerors shall be in compliance with all applicable laws of the federal and State governments relating to workers' compensation, unemployment compensation, payment of wages, and safety. Refer to Section 1.2, Website Reference for the Department of Labor and Industrial Relations (DLIR) website address.

• Business Registration. Prior to contracting, owners of all forms of business doing business in the State except sole proprietorships, charitable organizations, unincorporated associations and foreign insurance companies shall be registered and in good standing with the Department of Commerce and Consumer Affairs (DCCA), Business Registration Division. Foreign insurance companies must register with DCCA, Insurance Division. More information is on the DCCA website. Refer to Section 1.2, Website Reference for DCCA website address.

• State agencies can award amounts of $2,500.00 or greater only to those companies that are registered with Hawaii Compliance Express (HCE). The HCE is an electronic system that allows companies doing business with State or County agencies to quickly and easily obtain proof that they are compliant with applicable laws. The HCE certificate, “Certificate of Vendor Compliance,” is submitted in place of a tax clearance, labor certificate, and a Certificate of Good Standing required in Hawaii Revised Statues (HRS) §103-D-310(c) and Hawaii Administrative Rules (HAR) §3- 122-112. Refer to Section 1.2, Website Reference, for HCE’s website address.

E. Wages Law Compliance. If applicable, by submitting a proposal, the Offeror certifies that the Offeror is in compliance with HRS §103-55, Wages, hours, and working conditions of employees of Contractors performing services. Refer to Section 1.2, Website Reference for statutes and DLIR website address.

F. Campaign Contributions by State and County Contractors. HRS §11-355 prohibits campaign contributions from certain State or county government Contractors during the term of the contract if the Contractors are paid with funds appropriated by a legislative body. Refer to Section 1.2, Website Reference for statutes and Campaign Spending Commission website address.

G. Confidential Information. If an Offeror believes any portion of a proposal contains information that should be withheld as confidential, the Offeror shall request in writing nondisclosure of designated proprietary data to be confidential and provide justification to support confidentiality. Such data shall accompany the proposal, be clearly marked, and shall be readily separable from the proposal to facilitate eventual public inspection of the non-confidential sections of the proposal.

Note that price is not considered confidential and will not be withheld.

H. Proposal Submittal. The State has established the Hawaii State eProcurement (HIePRO) System to promote an open and transparent system for vendors to compete for State contracts electronically. Offerors interested in responding to this solicitation must be registered on HIePRO. Registration information is available at the State Procurement Office website: http://spo.hawaii.gov/HIEPRO/; select HIEPRO Vendor Registration, then HIEPRO Vendor Registration Guide.

All proposals shall be submitted via HIePRO at the date and time indicated in the solicitation, and in strict accordance with the instructions herein. The RFP Process, including issuance of the RFP, submission of Proposals, issuance of Addenda, and changes to the Procurement Timetable in Section 1.1 shall be conducted through HIEPRO. The State shall not be responsible for the failure of any Offeror to receive the RFP Process information.

The Contractor shall be subject to a one-time mandatory HIEPRO fee of .75% (.0075) of the award amount or $5,000, whichever is less. HIePRO is administered by Tyler Technologies, Inc. Tyler Technologies, Inc. shall invoice the Contractor directly for payment of the HIEPRO fee. Payment must be made within thirty (30) days from receipt of invoice.

1.12 Discussions

A. Prior to Submittal Deadline. Discussions may be conducted with potential Offerors to promote understanding of the purchasing agency’s requirements.

B. After Proposal Submittal Deadline. Discussions may be conducted with Offerors whose proposals are determined to be reasonably susceptible of being selected for award, but proposals may be accepted without discussions, in accordance with

HAR §3-122-53.

1.13 Additional Materials and Documentation

Upon request from the State purchasing agency, each Offeror shall submit additional materials and documentation reasonably required by the State purchasing agency in its evaluation of the proposals.

1.14 RFP Amendments

The State reserves the right to amend this RFP at any time prior to the closing date for final revised proposals.

1.15 Best and Final Offer

DOH, in its sole discretion, may request each Priority Listed Offeror to submit its Best http://spo.hawaii.gov/HIEPRO/ and Final Offer (“BAFO”). The request shall be issued in an Addendum which will provide guidance and additional instructions. BAFOs shall be submitted to the DOH RFP Contact Person via HIePRO on or before the deadline provided in Section 1.1 Procurement Timetable. If a Priority Listed Offeror fails to submit a BAFO, its last submitted offer shall be deemed to be its BAFO.

1.16 Cancellation of Request for Proposals

The RFP may be canceled and any or all proposals may be rejected in whole or in part, when it is determined to be in the best interest of the State.

1.17 Costs for Proposal Preparation

Any costs incurred by Offerors in preparing or submitting a proposal are the Offerors’ sole responsibility.

1.18 Rejection of Proposals

The State reserves the right to consider as acceptable only those proposals submitted in accordance with all requirements set forth in this RFP and which demonstrate an understanding of the problems involved and comply with the service specifications. Any proposal offering any other set of terms and conditions contradictory to those included in this RFP may be rejected without further notice.

A proposal may be rejected as authorized under HAR § 3-122 Subchapter 11.

1.19 Notice of Award

A Notice of Award of the Contract shall be made to the responsible Offeror whose Proposal is determined the most advantageous to the State, taking into consideration all the evaluation factors set forth in this RFP.

The Notice of Award shall be made available in HIePRO. Failure by the chosen vendor to accept the award within five days of the Notice of Award will be deemed a rejection of the award.

Any agreement arising out of this solicitation is subject to the approval of the Department of the Attorney General as to form, and to all further approvals, including the approval of the Governor, required by statute, regulation, rule, order or other directive. No work is to be undertaken by the Contractor(s) awarded a contract prior to the contract commencement date. The State of Hawaii is not liable for any costs incurred prior to the official starting date.

1.20 Debriefing

Pursuant to HAR §3-122-60, a non-selected Vendor may request a debriefing to understand the basis for award. The written request for debrief shall be sent to:

Candice.Bryant@doh.hawaii.gov.

A written request for debriefing shall be made within three (3) working days after the posting of the award of the contract. The Procurement Officer or designee shall hold the debriefing within seven (7) working days to the extent practicable from the receipt date of written request.

Any protest by the requestor following a debriefing, shall be filed within five (5) working days, as specified in HAR §103D-303(h).

1.21 Protests

Pursuant to HRS §103D-701 and HAR Chapter 3-126, an Offeror aggrieved by a solicitation or an award of a contract may file a protest, provided that no protest based upon the content of the solicitation shall be considered unless it is submitted in writing prior to the date set for the receipt of offers. Refer to Section 1.2, Website Reference for website address. Only the following matters may be protested:

(1) A State purchasing agency’s failure to follow procedures established by Chapter 103D of the Hawaii Revised Statutes;

(2) A State purchasing agency’s failure to follow any rule established by Chapter 103D of the Hawaii Revised Statutes; and

(3) A State purchasing agency’s failure to follow any procedure, requirement, or evaluation criterion in a request for proposals issued by the State purchasing agency.

(4) Protests based on the content of the solicitation will not be accepted after the solicitation closing date, in accordance with HRS 103D-701.

Any protest shall be submitted in writing to the Procurement Officer identified in HIePRO, addressed to:

Procurement Officer Name: Candice Bryant Title: Program and System Management Supervisor Mailing Address: 250 S. Hotel St. Suite 406 Honolulu, HI 96813 Business Address: 250 S. Hotel St. Suite 406 Honolulu, HI 96813

1.22 Availability of Funds

The award of a contract and any allowed renewal or extension thereof, is subject to allotments made by the Director of Finance, State of Hawaii, pursuant to HRS Chapter 37, and in accordance with §103D-309, HRS, and subject to the availability and allotment of State and/or Federal funds.

1.23 General and Special Conditions of Contract

The general conditions that will be imposed contractually are on the SPO website.

Special conditions may also be imposed contractually by the State purchasing agency, as deemed necessary.

1.24 Cost Principles

To promote uniform purchasing practices among State purchasing agencies procuring goods, services, and construction under HRS Chapter 103D, State purchasing agencies will utilize standard cost principles as outlined on the SPO website. Refer to Section 1.2 Website Reference for website address. Nothing in this section shall be construed to create an exemption from any cost principle arising under federal law.

1.25 Contract Execution

The successful Offeror shall enter into a formal written contract with the State. In submitting a proposal, the Offeror will be deemed to have agreed to each provision set forth in Attachment D, General Conditions. The State shall have no obligation to accept terms and conditions that vary from those set forth in the aforementioned attachment.

The Contract shall include or be deemed to incorporate this RFP, the Offeror's Proposal or BAFO, State AG General Conditions (“GC”) set forth in Attachment D, and any other terms as may be agreed to by the State and the Contractor.

Upon selection and award of the contract, the State shall send the formal contract to the successful Offeror via an electronic signature process. The State reserves the right to cancel any contract and request new proposals or negotiate with remaining Offerors if the State is not satisfied with the awarded Contractor’s performance.

No work is to be undertaken by the Offeror awarded a contract prior to the execution of a formal contract and the contract commencement date. The State of Hawaii is not liable for any costs incurred prior to the contract commencement date.

No contract shall be considered binding upon the State until the contract has been fully and properly executed by all parties thereto.

Section 2

Service Specifications

Section 2 Service Specifications

2.1 Introduction

A. Background

The Executive Office on Aging (“EOA”) serves as the designated State Unit on Aging for Hawaiʻi and is responsible for coordinating a Statewide system of services and supports for older adults and caregivers pursuant to federal and State law. Under the Older Americans Act (“OAA”), EOA administers programs and services that support older adults, family caregivers, and individuals with Long-Term Services and Supports (“LTSS”) needs.

EOA oversees Hawaiʻi’s Aging and Disability Resource Center (“ADRC”) Network, which includes ADRC sites operated by the Area Agencies on Aging (“AAAs”) in each county. The ADRCs serve as a primary point of access for individuals seeking information, assistance, and access to LTSS programs and services.

EOA also coordinates Hawaiʻi’s No Wrong Door (“NWD”) System, which brings together State and community partners to provide streamlined access to LTSS information and services. As part of the NWD system, participating agencies conduct administrative activities that support the efficient administration of Hawaiʻi’s Medicaid program, including outreach, screening, referrals, and assistance with Medicaid applications.

The Hawaiʻi Department of Human Services, Med-QUEST Division (“MQD”), administers the State Medicaid program. Through a Memorandum of Understanding between EOA and MQD, EOA and participating agencies are eligible to receive Medicaid Administrative Claiming (“MAC”) reimbursement for allowable administrative activities that support the Medicaid program.

To support MAC claiming, EOA must maintain a federally compliant methodology for determining the proportion of staff time attributable to Medicaid-related administrative activities and for calculating quarterly administrative claims. This methodology includes the use of federally approved twice-daily stratified Random Moment Sampling (“RMS”) and associated cost allocation processes.

At contract commencement, the MAC program will support the Executive Office on Aging and participating Area Agencies on Aging operating the ADRC Network. During the two-year contract term, the State anticipates the program to support approximately 8 to 12 participating agencies and programs and approximately 50 to 80 staff participating in the RMS process.

Based on planning estimates developed during the State's Cost Allocation Plan ("CAP") process, the MAC program is anticipated to generate approximately $1.7 million to $2.2 million in annual federal Medicaid administrative reimbursement. This information is provided solely to assist Offerors in understanding the approximate scale of the program. Actual reimbursement amounts may vary based on eligible expenditures, program participation, federal requirements, and other factors.

To support these activities, EOA is seeking a qualified Contractor to provide technical, administrative, and operational support for Hawaiʻi's Medicaid Administrative Claiming program as described in Section 2.4, Scope of Work.

B. Description of the Service Goals

EOA seeks a qualified Contractor to provide technical, administrative, and operational support for Hawaiʻi’s Medicaid Administrative Claiming program. The Contractor shall operate and maintain a federally compliant Random Moment Sampling (“RMS”) system, support claim development and calculation activities, provide training and technical assistance to participating agencies, and assist EOA in preparing quarterly Medicaid Administrative Claims.

2.2 Contract Monitoring and Evaluation

The Contractor’s performance under the Contract will be monitored and evaluated by the Contract Administrator or his/her designated representative.

Failure to comply with all material terms of the Contract may be cause for suspension or termination as provided in the General Conditions. The Contractor may be required to submit additional written reports, including a corrective action plan, in response to monitoring conducted by the EOA. These additional reports will not be considered a change to the scope of work and will continue for a duration of time as deemed necessary by the EOA.

2.3 General Requirements

The Offeror shall demonstrate that it possesses the experience, qualifications, and organizational capacity necessary to successfully perform the services described in this Request for Proposals.

At a minimum, the Offeror shall:

1. Have a minimum of three (3) years of experience providing Medicaid Administrative Claiming ("MAC") consulting, implementation, administration, or related services for State government agencies.

2. Demonstrate experience supporting the development, implementation, operation, or enhancement of Medicaid Administrative Claiming programs, including stratified Random Moment Sampling ("RMS"), cost allocation methodologies, claim calculation, or related activities.

3. Provide a description of at least two (2) State government projects completed within the past five (5) years that are similar in scope and complexity to the services requested under this RFP. The description shall identify the client agency, project period, services provided, and outcomes achieved.

4. Submit two (2) letters of reference or support from State government agencies for which the Offeror has provided Medicaid Administrative Claiming services. The letters shall be included as part of the proposal, dated within the past three (3) years, and include the name and contact information of a representative of the agency. The State may contact the referenced representatives to verify the information provided and evaluate the Offeror's past performance.

2.4 Scope of Work

EOA seeks a qualified Contractor to provide technical, administrative, and operational support for Hawaiʻi’s Medicaid Administrative Claiming program. The Contractor shall operate and maintain a federally compliant Random Moment Sampling (“RMS”) system, support claim development and calculation activities, provide training and technical assistance to participating agencies, and assist EOA in preparing quarterly Medicaid Administrative Claims.

The Contractor shall provide a secure, web-based solution that supports RMS administration, reporting, claim calculation, documentation, and ongoing program management.

The Scope of Work encompasses the following tasks and responsibilities:

A. Random Moment Sampling Administration

The Contractor shall provide, operate, and maintain a secure, cloud-hosted web-based Random Moment Sampling (“RMS”) system that supports Medicaid Administrative Claiming (“MAC”) activities.

The Contractor shall:

1. Operate and administer a statistically valid twice-daily stratified RMS process that complies with applicable federal Medicaid requirements and cost allocation principles.

2. Maintain a web-based RMS application accessible through standard internet browsers without requiring installation of software on State-owned devices.

3. Configure and maintain RMS participant pools, activity codes, schedules, and sampling methodologies necessary to support the MAC program.

4. Generate and distribute random moments to participating staff.

5. Monitor participant response rates and conduct follow-up activities as necessary to maximize compliance.

6. Provide administrative tools that allow EOA to monitor participation and review sampling results.

7. Maintain appropriate system security, user management, and data retention practices.

8. Operate the RMS process for all quarters during the contract period.

9. Develop and implement enhancements to the RMS or cost allocation system.

B. Medicaid Administrative Claim Development and Calculation

The Contractor shall support the preparation and calculation of Medicaid Administrative Claims.

The Contractor shall:

1. Review and document the methodology used to develop quarterly Medicaid Administrative Claims.

2. Collect and compile RMS results and expenditure information provided by EOA and participating agencies.

3. Calculate quarterly Medicaid Administrative Claims using approved methodologies and cost allocation procedures.

4. Prepare claim calculation workpapers and supporting documentation sufficient for State and federal review.

5. Develop claim summaries and reports for EOA review and approval.

6. Submit draft quarterly claim packages to EOA in accordance with timelines established by EOA.

7. Provide technical assistance related to claim calculations, supporting documentation, and audit inquiries.

8. Support a monthly five percent quality assurance review process conducted by participating agencies and EOA.

C. Reporting and Program Support

The Contractor shall provide reporting and program management support.

The Contractor shall:

1. Develop Statewide and agency-specific reports that summarize RMS participation, coding results, response rates, and claiming outcomes.

2. Provide quarterly and ad hoc reports requested by EOA.

3. Generate monthly agency participation reports.

4. Identify participation issues, data anomalies, or operational concerns and recommend corrective actions.

5. Participate in meetings with EOA, MQD, participating agencies, and other stakeholders as requested.

6. Maintain documentation of processes, procedures, and methodologies used to support MAC activities.

7. Assist with modifications to the Cost Allocation Plan (“CAP”).

D. Training and Technical Assistance

The Contractor shall provide training and technical assistance to EOA and participating agencies.

The Contractor shall:

1. Develop training materials, user guides, and reference documents related to RMS participation and MAC processes.

2. Conduct initial and refresher training sessions for RMS participants, supervisors, and administrators.

3. Provide ongoing technical assistance and support during normal business hours.

4. Respond to participant and administrator inquiries regarding system access, RMS completion requirements, and claim-related processes.

E. Deliverables

The Contractor shall provide the following deliverables:

1. Web-based RMS system and ongoing system administration.

2. Quarterly RMS administration and monitoring reports.

3. Quarterly Medicaid Administrative Claim calculation packages.

4. Supporting claim documentation and workpapers.

5. Training materials and user guides.

6. Documentation of methodologies and procedures.

7. Quarterly status reports summarizing activities, accomplishments, issues, and recommendations.

8. Monthly agency participation reports.

F. Work Plan

Within thirty (30) days of contract execution, the Contractor shall submit a detailed work plan for EOA approval. The work plan shall include timelines, milestones, responsible staff, deliverables, and communication protocols necessary to complete all activities described in this scope of services.

Following contract award, the successful Contractor will be provided applicable program documentation, including the State's approved Cost Allocation Plan ("CAP"), necessary to perform the required services.

The Contractor shall be fully operational in accordance with the implementation schedule approved by EOA and prepared to support the first Medicaid Administrative Claiming quarter following contract commencement, currently anticipated to be October–December 2026.

Section 3

Proposal Application Instructions

Section 3 Proposal Instructions

General instructions for completing proposals:

• Proposals shall be submitted to the State purchasing agency using the prescribed format outlined in this section.

• Page numbering of the Proposal should be consecutive, beginning with page one and continuing through for each section.

• Offerors must also include a Table of Contents with the Proposal which shall coincide with the order of this RFP. A sample Table of Contents is attached hereto as Attachment C.

• A written response is required for each item unless indicated otherwise. Failure to answer any of the items will impact upon an Offeror’s score.

• Offerors are strongly encouraged to review evaluation criteria in Section 4, Evaluation Criteria, when completing the proposal.

The Offeror shall organize its proposal in the following order:

1. Proposal Identification Form (OF-1)

2. Proposal Offer Form (OF-2)

3. Table of Contents

4. Program Overview

5. Organizational Experience and Qualifications

6. Understanding of Project Requirements and Proposed Approach

7. Work Plan and Service Delivery

8. Staffing and Organizational Structure

9. Data Management, Reporting, and Quality Assurance

10. Cost Proposal and Budget Narrative

11. Other and attachments

3.1 Proposal Identification Form

The Offeror shall submit the Proposal Identification Form (Form OF-1), attached hereto as Attachment A, to allow evaluators to properly identify the organization submitting the proposal.

3.2 Proposal Offer Form

The Offeror shall submit the Proposal Offer Form (Form OF-2), attached hereto as Attachment B. The Proposal Offer Form shall summarize the Offeror's proposed budget by contract year and total proposed budget.

3.3 Table of Contents

The Offeror shall provide a table of contents to inform evaluators where to locate required information. A sample Table of Contents is attached hereto as Attachment C.

3.4 Program Overview

The Offeror shall give a brief overview to orient evaluators as to the program operations and services being offered.

3.5 Organizational Experience and Capability

The Offeror must demonstrate capability and knowledge to perform the services listed in section 2.4, Scope of Work and meet all requirements listed in section 2.3, General Requirements. All requirements listed in sections 2.4, Scope of Work, and 2.3, General Requirements, must be addressed. Provide as much detail as possible to show experience in completing the Scope of Work.

3.6 Understanding of Project Requirements and Proposed Approach

The Offeror shall demonstrate its understanding of the services requested under this RFP and describe its proposed methodology for performing the Scope of Work listed in section 2.4.

3.7 Work Plan and Service Delivery

The Offeror must demonstrate its plan for implementing services and meeting project objectives listed in section 2.4, Scope of Work.

3.8 Staffing and Organizational Structure

The Offeror shall describe its proposed staffing structure and organizational capacity to successfully perform the services described in section 2.4, Scope of Work.

3.9 Data Management, Reporting, and Quality Assurance

The Offeror shall describe its ability to manage data, maintain accuracy, and ensure quality of services and reporting as listed in section 2.4, Scope of Work.

3.10 Cost Proposal and Budget Narrative

The Offeror shall submit a Cost Proposal and Budget Narrative as part of its proposal.

The Cost Proposal shall provide a separate budget for each contract year and identify all costs necessary to perform the services described in this RFP.

The maximum compensation available under this procurement is $350,000.00.

For proposal purposes, the State anticipates funding of approximately:

• Contract Year 1: $210,000.00

• Contract Year 2: $140,000.00

These annual funding amounts reflect the anticipated distribution of implementation and ongoing operational activities and are provided for proposal preparation and evaluation purposes only. They do not establish separate contractual funding limits or guarantee funding by contract year.

Contract Year 1 funding is intended to support system implementation and start-up activities, including onboarding, implementation of the Random Moment Sampling (RMS) system, training, and quarterly Medicaid Administrative Claiming activities.

Contract Year 2 funding is intended to support ongoing operation of the RMS system, quarterly claiming activities, continued onboarding of participating agencies, training, and ongoing technical support.

The Cost Proposal shall identify all anticipated costs necessary to perform the services described in this RFP. The proposal shall clearly identify costs by contract year and include sufficient detail to allow the State to evaluate the reasonableness and completeness of the proposed budget.

The Offeror shall submit a Budget Narrative describing the basis for each proposed cost, including the assumptions and methodology used to develop the proposed budget. If the Offeror proposes a materially different distribution of costs between Contract Year 1 and Contract Year 2 than the anticipated funding amounts identified above, the Budget Narrative shall explain the basis for the proposed allocation. The narrative shall demonstrate that the proposed costs are reasonable, necessary, and directly support the Scope of Work.

The Offeror shall describe its fiscal management practices, including its accounting system and internal controls, sufficient to demonstrate its ability to manage contract funds, track expenditures, and maintain documentation required for State and federal audit purposes.

The Offeror may include any additional budget narrative, cost justification, or supporting documentation deemed necessary to clearly explain and justify proposed costs and to demonstrate cost reasonableness and alignment with the Scope of Work.

3.11 Other and Attachments

Litigation: The Offeror shall disclose and explain any pending litigation to which they are a party, including the disclosure of any outstanding judgment.

Section 4

Proposal Evaluation

Organization:

RFP No:

Section 4 Proposal Evaluation

4.1 Introduction

The evaluation of proposals received in response to the RFP will be conducted comprehensively, fairly, and impartially. Structural, quantitative scoring techniques will be utilized to maximize the objectivity of the evaluation.

4.2 Evaluation Process

The procurement officer or an evaluation committee of designated reviewers selected by the head of the State purchasing agency or procurement officer shall review and evaluate proposals. When an evaluation committee is utilized, the committee will be comprised of individuals with experience in, knowledge of, and program responsibility for program services, funding, and reporting.

The evaluation will be conducted in three phases as follows:

• Phase 1 - Evaluation of Proposal Requirements

• Phase 2 - Evaluation of Proposal

• Phase 3 - Recommendation for Award

Evaluation Categories and Thresholds

Evaluation Categories

Possible Points

Program Overview 0 points Organizational Experience and Qualifications 25 points Understanding of Project Requirements and Proposed Approach

25 points

Work Plan and Service Delivery 20 points Staffing and Organizational Structure 15 points Data Management, Reporting, and Quality Assurance 5 points Cost Proposal and Budget Narrative 10 points

TOTAL POSSIBLE POINTS 100 Points

4.3 Evaluation Criteria

A. Phase 1 - Evaluation of Proposal Requirements

1. Administrative Requirements The State shall review each proposal to determine whether the Offeror has met all administrative and mandatory requirements outlined in Section 1 of this Request for Proposals.

Only proposals determined by the State to be responsive and compliant with the requirements of Section 1 shall advance to subsequent phases of evaluation. Proposals that fail to meet any required administrative or mandatory criteria may be deemed non-responsive and may not be considered for further evaluation.

2. Proposal Requirements

• Proposal Identification Form

• Proposal Offer Form

• Table of Contents

• Program Overview

• Organizational Experience and Qualifications

• Understanding of Project Requirements and Proposed

Approach

• Work Plan and Service Delivery

• Staffing and Organizational Structure

• Data Management, Reporting, and Quality Assurance

• Cost Proposal and Budget Narrative

• Other and attachments

B. Phase 2 - Evaluation of Proposal

The total number of points that an Offeror can achieve is 100.

To achieve the highest possible points, the Offeror should provide sufficient detail for each criterion in its proposal that will allow the evaluation committee to make a satisfactory judgment.

1. Program Overview: No points are assigned to Program Overview. The intent is to give the Offeror an opportunity to orient evaluators as to the service(s) being offered.

2. Organizational Experience (25 Points)

The State will evaluate the Offeror's demonstrated experience and qualifications to perform the proposed services.

a) Relevant Experience (15 Points) The Offeror shall describe:

• Experience implementing, administering, or supporting Medicaid Administrative Claiming ("MAC") programs for State government agencies.

• Experience developing, implementing, administering, or supporting Random Moment Sampling ("RMS") methodologies and systems.

• Experience supporting Cost Allocation Plans ("CAP"), cost allocation methodologies, and Medicaid administrative claiming processes.

• Experience operating web-based RMS, time study, or cost allocation systems.

• Experience preparing, calculating, or supporting Medicaid administrative claims and related documentation.

b) Organizational Capacity and References (10 Points)

The Offeror shall demonstrate:

• A minimum of three (3) years of experience providing MAC-related services to State government agencies.

• Organizational capacity to successfully provide the services described in this RFP.

• Experience providing services of similar size, scope, and complexity.

• Submission of two (2) letters of reference or support from State government agencies for which the Offeror has provided MAC services.

3. Understanding of Project Requirements and Proposed Approach (25 Points)

The State will evaluate the Offeror's understanding of project requirements and proposed methodology.

a) Understanding of Program Requirements (10 Points) The Offeror shall describe:

• Understanding of Medicaid Administrative Claiming ("MAC") requirements.

• Understanding of Random Moment Sampling ("RMS") methodologies and federal compliance requirements.

• Understanding of Cost Allocation Plan ("CAP") requirements and claiming methodologies.

• Understanding of the roles of EOA, the Area Agencies on Aging ("AAA"), Aging and Disability Resource Centers ("ADRC"), No Wrong Door ("NWD") partners, and MQD in the MAC process.

b) Proposed Technical and Operational Approach (15 Points) The Offeror shall describe

• Proposed methodology for administering RMS activities.

• Approach to collecting, validating, and utilizing expenditure data.

• Approach to calculating quarterly MAC claims.

• Approach to reporting, documentation, technical assistance, and stakeholder coordination.

4. Work Plan & Service Delivery (20 Points)

The State will evaluate the Offeror's proposed work plan and ability to implement the required services.

a) Work Plan and Project Management (10 Points) The Offeror shall provide:

• A detailed work plan with tasks, timelines, milestones, and deliverables.

• A project management approach for administering RMS activities and quarterly claim development.

• Procedures for monitoring performance and ensuring timely completion of deliverables.

• Strategies to address operational issues and maintain continuity of services.

b) System Operations, Training, and Technical Support (10 Points)

• Approach to hosting, operating, and maintaining the RMS system.

• Procedures for user support and technical assistance.

• Training approach for EOA staff and participating agencies.

• Approach to implementing system enhancements and supporting CAP modifications.

5. Staffing and Organizational Structure (15 Points)

The State will evaluate the Offeror's proposed staffing and organizational structure.

a) Staffing and Key Personnel (10 Points) The Offeror shall provide:

• Proposed staffing structure and key personnel assigned to the project.

• Qualifications, certifications, and experience of personnel responsible for RMS administration, MAC claiming, training, and technical support.

• Experience of project management staff overseeing similar projects.

• Description of…