RFP Document.pdf

STATE OF SOUTH DAKOTA

RURAL HEALTH TRANSFORMATION

DEPARTMENT OF HEALTH

600 EAST CAPITOL AVENUE

PIERRE, SD 57501

DSS Rural Health Transformation Primary Accountable Care Transformation Reimbursement Design

PROPOSALS ARE DUE NO LATER THAN APRIL 3rd, 2026, at 5PM CT

RFP # 26-08RHT-008 State POC: Kirsten Blachford EMAIL: Kirsten.Blachford@state.sd.us

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FIRM NAME: AUTHORIZED SIGNATURE:

ADDRESS: TYPE OR PRINT NAME:

CITY/STATE: TELEPHONE NO:

ZIP (9 DIGIT): FAX NO:

E-MAIL:

PRIMARY CONTACT INFORMATION

CONTACT NAME: TELEPHONE NO:

FAX NO: E-MAIL:

1.0 GENERAL INFORMATION

1.1 PURPOSE OF REQUEST FOR PROPOSAL (RFP)

The Rural Health Transformation initiative is a statewide effort focused on strengthening rural healthcare systems and improving access to quality care across South Dakota. Through strategic investments, innovative care models, and cross-agency collaboration, Rural Health Transformation is designed to build a more resilient, connected, and sustainable rural health system for communities across the state.

The South Dakota Department of Social Services, Division of Medical Services (Medicaid) is seeking a vendor to assist the State with developing a population-based alternative payment methodology for South Dakota Medicaid primary care services including:

Modeling a population-based primary care methodology;

Calculating the population-based payment amounts;

Calculating case management payment amount;

Developing a methodology for regular updates to the payment methodologies;

Developing a quality-based payment methodology based on provider performance on HEDIS or other quality measures;

Developing a recipient rewards program for meeting established goals;

Facilitating stakeholder engagement meetings;

The State is referring to this initiative as the Medicaid Primary Accountable Care Transformation (PACT).

It is envisioned that PACT will provide flexible, population-based payments to primary care practices and incentivize both providers and patients to achieve quality outcomes while promoting shared accountability for cost and utilization. The target implementation date for the methodology is January 1, 2028.

The population-based payments will primarily be limited to evaluation and management services provided in non-institutional settings. It is anticipated PACT will also have a fee-for-service track for providers who do not wish to receive a population-based payment. In addition, it is anticipated that the payment design will be flexible to include providers currently paid at an encounter rate such as Federally Qualified Health Centers, Rural Health Clinics, Indian Health Service Clinics, and Tribal 638 clinics.

The State estimates the model will include approximately 100,000 Medicaid recipients on a monthly basis. The State estimates that approximately $80 million in annual Medicaid expenditures may be eligible for inclusion in the population-based payments.

Implementation of the PACT model is being funded with Rural Health Transformation Program (RHTP) funding. For more information about the PACT model, please see the State’s RHTP project narrative https://doh.sd.gov/media/lyfbrd2k/sd_rhtproject-narrative-final.pdf.

1.2 ISSUING OFFICE AND RFP REFERENCE NUMBER

The Division of Medical Services is the issuing office for this document and all subsequent addenda relating to it, on behalf of the State of South Dakota, Department of Social Services. The reference number for the transaction is RFP26-08RHT-008. This number must be referred to on all proposals, correspondence, and documentation relating to the RFP.

1.3 LETTER OF INTENT

All interested offerors are requested to submit a non-binding Letter of Intent to respond to this RFP. While preferred, a Letter of Intent is not mandatory to submit a proposal.

Be sure to reference the RFP number in your letter.

The Letter of Intent may be submitted to Kirsten Blachford via email at Kirsten.Blachford@state.sd.us no later than March 13, 2026. Please place the following in the subject line of your email: “Letter of Intent for

RFP26-08RHT-008.

1.4 SCHEDULE OF ACTIVITIES (SUBJECT TO CHANGE)

RFP Publication 02/25/2026 Letter of Intent to Respond Due Offeror Questions Due

03/13/2026 03/13/2026

Responses to Offeror Questions Request for SFTP folder

03/20/2026 04/02/2026

Proposal Submission 04/03/2026 Oral Presentations/Discussions (if required) Proposal Revisions (if required)

TBD

TBD

Anticipated Award Decision/Contract Negotiation 04/30/2026

1.5 SUBMITTING YOUR PROPOSAL

All proposals must be completed and received in the Department of Social Services by the date and time indicated in the Schedule of Activities.

Proposals received after the deadline will be late and ineligible for consideration.

Proposals must be submitted as PDFs via Secured File Transfer Protocol (SFTP). Offerors must request an SFTP folder no later than the date indicated in the Schedule of Activities by emailing Kirsten Blachford at Kirsten.Blachford@state.sd.us.

The subject line should read “RFP26-08RHT-008 SFTP Request”. The email should contain the name and the email of the person who will be responsible for uploading the document(s).

Please note, offeror will need to work with their own technical support staff to set up an SFTP compatible software on offeror’s end. While the State of South Dakota can answer questions, State of South Dakota is not responsible for the software required.

All proposals may be signed in ink or digitally by an officer of the offeror legally authorized to bind the offeror to the proposal and sealed in the form intended by the respondent. Proposals that are not properly signed may be rejected.

No proposal may be accepted from, or any contract or purchase order awarded to any person, firm or corporation that is in arrears upon any obligations to the State of South Dakota, or that otherwise may be deemed irresponsible or unreliable by the State of South Dakota.

1.6 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION – LOWER TIER COVERED TRANSACTIONS

By signing and submitting this proposal, the offeror certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation, by any Federal department or agency, from transactions involving the use of Federal funds.

Where the offeror is unable to certify to any of the statements in this certification, the bidder shall attach an explanation to their offer.

1.7 NON-DISCRIMINATION STATEMENT

The State of South Dakota requires that all contractors, vendors, and suppliers doing business with any State agency, department, or institution, provide a statement of non-discrimination. By signing and submitting their proposal, the offeror certifies they do not discriminate in their employment practices with regard to race, color, creed, religion, age, sex, ancestry, national origin or disability.

1.8 CERTIFICATION RELATING TO PROHIBITED ENTITY

For contractors, vendors, suppliers, or subcontractors who enter into a contract with the State of South Dakota by submitting a response to this solicitation or agreeing to contract with the State, the bidder or offeror certifies and agrees that the following information is correct:

The bidder or offeror, in preparing its response or offer or in considering proposals submitted from qualified, potential vendors, suppliers, and subcontractors, or in the solicitation, selection, or commercial treatment of any vendor, supplier, or subcontractor, is not an entity, regardless of its principal place of business, that is ultimately owned or controlled, directly or indirectly, by a foreign national, a foreign parent entity, or foreign government from China, Iran, North Korea, Russia, Cuba, or Venezuela, as defined by SDCL 5-18A. It is understood and agreed that, if this certification is false, such false certification will constitute grounds for the State to reject the bid or response submitted by the bidder or offeror on this project and terminate any contract awarded based on the bid or response. The successful bidder or offeror further agrees to provide immediate written notice to the contracting executive branch agency if during the term of the contract it no longer complies with this certification and agrees such noncompliance may be grounds for contract termination.

1.9 RESTRICTION OF BOYCOTT OF ISRAEL

For contractors, vendors, suppliers, or subcontractors with five (5) or more employees who enter into a contract with the State of South Dakota that involves the expenditure of one hundred thousand dollars ($100,000) or more, by submitting a response to this solicitation or agreeing to contract with the State, the bidder or offeror certifies and agrees that the following information is correct:

The bidder or offeror, in preparing its response or offer or in considering proposals submitted from qualified, potential vendors, suppliers, and subcontractors, or in the solicitation, selection, or commercial treatment of any vendor, supplier, or subcontractor, has not refused to transact business activities, has not terminated business activities, and has not taken other similar actions intended to limit its commercial relations, related to the subject matter of the bid or offer, with a person or entity on the basis of Israeli national origin, or residence or incorporation in Israel or its territories, with the specific intent to accomplish a boycott or divestment of Israel in a discriminatory manner. It is understood and agreed that, if this certification is false, such false certification will constitute grounds for the State to reject the bid or response submitted by the bidder or offeror on this project and terminate any contract awarded based on the bid or response. The successful bidder or offeror further agrees to provide immediate written notice to the contracting executive branch agency if during the term of the contract it no longer complies with this certification and agrees such noncompliance may be grounds for contract termination.

1.10 MODIFICATION OR WITHDRAWAL OF PROPOSALS

Proposals may be modified or withdrawn by the offeror prior to the established due date and time.

No oral, telephonic, telegraphic or facsimile responses or modifications to informal, formal bids, or Request for Proposals will be considered.

1.11 OFFEROR INQUIRIES

Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after the date and time indicated in the Schedule of Activities. Inquiries must be emailed to Kirsten Blachford at Kirsten.Blachford@state.sd.us with the subject line “RFP26-08RHT-008”.

The State will respond to offeror’s inquiries (if required) via e-mail. In addition, all inquiries and the State’s response will be posted on the state’s e-procurement system and the DSS website at http://dss.sd.gov/keyresources/rfp.aspx. Offerors may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP.

1.12 PROPRIETARY INFORMATION

The proposal of the successful offeror(s) becomes public information. Proprietary information can be protected under limited circumstances such as client lists and non-public financial statements. An entire proposal may not be marked as proprietary. Offerors must clearly identify in the Executive Summary and mark in the body of the proposal any specific proprietary information they are requesting to be protected.

The Executive Summary must contain specific justification explaining why the information is to be protected. Proposals may be reviewed and evaluated by any person at the discretion of the State. All materials submitted become the property of the State of South Dakota and may be returned only at the State's option.

1.13 LENGTH OF CONTRACT

The contract resulting from this RFP will be issued for the period of three (3) years beginning on or near June 1, 2026 and ending May 31, 2029, with the option for renewal for up to two (2), one (1) year contracts at the discretion of the State based on performance and/or the continued availability of funds.

Contracts will be negotiated on an annual basis.

1.14 GOVERNING LAW

Venue for any and all legal action regarding or arising out of the transaction covered herein shall be solely in the State of South Dakota. The laws of South Dakota shall govern this transaction.

1.15 DISCUSSIONS WITH OFFERORS (ORAL PRESENTATION/NEGOTIATIONS)

An oral presentation by an offeror to clarify a proposal may be required at the sole discretion of the State.

However, the State may award a contract based on the initial proposals received without discussion with the Offeror. If oral presentations are required, they will be scheduled after the submission of proposals.

Oral presentations will be made at the offeror’s expense.

This process is a Request for Proposal/Competitive Negotiation process. Each Proposal shall be evaluated, and each respondent shall be available for negotiation meetings at the State’s request. The State reserves the right to negotiate on any and/or all components of every proposal submitted. From the time the proposals are submitted until the formal award of a contract, each proposal is considered a working document and as such, will be kept confidential. The negotiation discussions will also be held as confidential until such time as the award is completed.

2.0 STANDARD CONTRACT TERMS AND CONDITIONS

Any contract or agreement resulting from this RFP will include the State’s standard terms and conditions as listed below, along with any additional terms and conditions as negotiated by the parties:

2.1 The Contractor will perform those services described in the Scope of Work, attached hereto as Section 3 of the RFP and by this reference incorporated herein.

2.2 The Contractor’s services under this Agreement shall commence on ___ and end on ___, unless sooner terminated pursuant to the terms hereof.

2.3 The Contractor will not use State equipment, supplies or facilities. The Contractor will provide the State with its Employer Identification Number, Federal Tax Identification Number or Social Security Number upon execution of this Agreement.

2.4 The State will make payment for services upon satisfactory completion of the services. The TOTAL

CONTRACT AMOUNT is an amount not to exceed $___. The State will not pay Contractor's expenses as a separate item. Payment will be made pursuant to itemized invoices submitted with a signed state voucher.

Payment will be made consistent with SDCL ch. 5-26.

2.5 The Contractor agrees to indemnify and hold the State of South Dakota, its officers, agents and employees, harmless from and against any and all actions, suits, damages, liability or other proceedings that may arise as the result of performing services hereunder. This section does not require the Contractor to be responsible for or defend against claims or damages arising solely from errors or omissions of the State, its officers, agents or employees.

2.6 The Contractor, at all times during the term of this Agreement, shall obtain and maintain in force insurance coverage of the types and with the limits as follows:

A. Commercial General Liability Insurance:

The Contractor shall maintain occurrence based commercial general liability insurance or equivalent form with a limit of not less than $1,000,000.00 for each occurrence. If such insurance contains a general aggregate limit it shall apply separately to this Agreement or be no less than two times the occurrence limit.

B. Professional Liability Insurance or Miscellaneous Professional Liability Insurance:

The Contractor agrees to procure and maintain professional liability insurance or miscellaneous professional liability insurance with a limit not less than $1,000,000.00.

C. Business Automobile Liability Insurance:

The Contractor shall maintain business automobile liability insurance or equivalent form with a limit of not less than $1,000,000.00 for each accident. Such insurance shall include coverage for owned, hired and non-owned vehicles.

D. Worker’s Compensation Insurance:

The Contractor shall procure and maintain workers’ compensation and employers’ liability insurance as required by South Dakota law.

Before beginning work under this Agreement, Contractor shall furnish the State with properly executed Certificates of Insurance which shall clearly evidence all insurance required in this Agreement. In the event a substantial change in insurance, issuance of a new policy, cancellation or nonrenewal of the policy, the Contractor agrees to provide immediate notice to the State and provide a new certificate of insurance showing continuous coverage in the amounts required.

Contractor shall furnish copies of insurance policies if requested by the State.

2.7 While performing services hereunder, the Contractor is an independent contractor and not an officer, agent, or employee of the State of South Dakota.

2.8 Contractor agrees to report to the State any event encountered in the course of performance of this Agreement which results in injury to the person or property of third parties, or which may otherwise subject Contractor or the State to liability. Contractor shall report any such event to the State immediately upon discovery.

Contractor's obligation under this section shall only be to report the occurrence of any event to the State and to make any other report provided for by their duties or applicable law. Contractor's obligation to report shall not require disclosure of any information subject to privilege or confidentiality under law (e.g., attorney-client communications). Reporting to the State under this section shall not excuse or satisfy any obligation of Contractor to report any event to law enforcement or other entities under the requirements of any applicable law.

2.9 This Agreement may be terminated by either party hereto upon thirty (30) days written notice. In the event the Contractor breaches any of the terms or conditions hereof, this Agreement may be terminated by the State at any time with or without notice. If termination for such a default is effected by the State, any payments due to Contractor at the time of termination may be adjusted to cover any additional costs to the State because of Contractor's default. Upon termination the State may take over the work and may award another party an agreement to complete the work under this Agreement. If after the State terminates for a default by Contractor it is determined that Contractor was not at fault, then the Contractor shall be paid for eligible services rendered and expenses incurred up to the date of termination.

2.10 This Agreement depends upon the continued availability of appropriated funds and expenditure authority from the Legislature for this purpose. If for any reason the Legislature fails to appropriate funds or grant expenditure authority, or funds become unavailable by operation of law or federal funds reductions, this Agreement will be terminated by the State. Termination for any of these reasons is not a default by the State nor does it give rise to a claim against the State.

2.11 This Agreement may not be assigned without the express prior written consent of the State. This Agreement may not be amended except in writing, which writing shall be expressly identified as a part hereof, and be signed by an authorized representative of each of the parties hereto.

2.12 This Agreement shall be governed by and construed in accordance with the laws of the State of South

Dakota. Any lawsuit pertaining to or affecting this Agreement shall be venued in Circuit Court, Sixth Judicial Circuit, Hughes County, South Dakota.

2.13 The Contractor will comply with all federal, state and local laws, regulations, ordinances, guidelines, permits and requirements applicable to providing services pursuant to this Agreement, and will be solely responsible for obtaining current information on such requirements.

2.14 The Contractor may not use subcontractors to perform the services described herein without the express prior written consent of the State. The Contractor will include provisions in its subcontracts requiring its subcontractors to comply with the applicable provisions of this Agreement, to indemnify the State, and to provide insurance coverage for the benefit of the State in a manner consistent with this Agreement. The Contractor will cause its subcontractors, agents, and employees to comply, with applicable federal, state and local laws, regulations, ordinances, guidelines, permits and requirements and will adopt such review and inspection procedures as are necessary to assure such compliance.

2.15 Contractor hereby acknowledges and agrees that all reports, plans, specifications, technical data, miscellaneous drawings, software system programs and documentation, procedures, or files, operating instructions and procedures, source code(s) and documentation, including those necessary to upgrade and maintain the software program, and all information contained therein provided to the State by the Contractor in connection with its performance of services under this Agreement shall belong to and is the property of the State and will not be used in any way by the Contractor without the written consent of the State. Papers, reports, forms, software programs, source code(s) and other material which are a part of the work under this Agreement will not be copyrighted without written approval of the State.

2.16 The Contractor certifies that neither Contractor nor its principals are presently debarred, suspended, proposed for debarment or suspension, or declared ineligible from participating in transactions by the federal government or any state or local government department or agency. Contractor further agrees that it will immediately notify the State if during the term of this Agreement Contractor or its principals become subject to debarment, suspension or ineligibility from participating in transactions by the federal government, or by any state or local government department or agency.

2.17 Any notice or other communication required under this Agreement shall be in writing and sent to the address set forth above. Notices shall be given by and to ___ on behalf of the State, and by ___, on behalf of the Contractor, or such authorized designees as either party may from time to time designate in writing. Notices or communications to or between the parties shall be deemed to have been delivered when mailed by first class mail, provided that notice of default or termination shall be sent by registered or certified mail, or, if personally delivered, when received by such party.

2.18 In the event that any court of competent jurisdiction shall hold any provision of this Agreement unenforceable or invalid, such holding shall not invalidate or render unenforceable any other provision hereof.

2.19 All other prior discussions, communications and representations concerning the subject matter of this

Agreement are superseded by the terms of this Agreement, and except as specifically provided herein, this Agreement constitutes the entire agreement with respect to the subject matter hereof.

2.20 This contract is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S.

Department of Health and Human Services (HHS) as part of a financial assistance award totaling $___ with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

3.0 SCOPE OF WORK

The South Dakota Department of Social Services (DSS), Division of Medical Services is seeking a qualified vendor to provide payment development and modeling consulting services for an alternative payment model for primary care practices. The vendor will provide recommendations for value-based payment models that incentivize providers and patients and promote shared accountability for cost and utilization. The vendor will use data from the Division to model multiple payment model options and make a final recommendation for an appropriate payment model.

Proposals must provide a detailed response describing how each of the following requirements and sub-requirements will be met.

3.1 Project Approach

3.1.1 Applicants must provide a narrative describing their overall approach to complete the Scope of Work outlined in Section 3.0 within the timeline available for the work.

3.1.2 Applicants are expected to demonstrate a plan for the alternative payment methodology, incorporating iterative feedback from the state and stakeholders.

3.1.3 Applicants must provide a narrative describing their familiarity with providing the requested Scope of Work.

3.1.4 Applicants must plan to attend a project inception meeting within seven days of contract initiation (virtual or in person) and articulate to the State in its response what information would be needed to best guide the applicant’s approach given the timeline and scope outlined in this proposal.

3.2 Model Development and Rate Methodology

3.2.1 Applicants must describe their plan to determine and validate historical primary care costs using claims data provided by the Division of Medical Services.

3.2.2 Applicants must describe their plan to apply adjustments to historical rates to reflect future changes in primary care costs and utilization. These adjustments must be based on expected market changes and follow standard actuarial principles.

3.2.3 Applicants must describe their plan to determine which Medicaid recipients to include in the alternative payment methodology, and how recipients will be tiered within the methodology.

3.2.4 Applicants must describe their plan to refine and recommend the services which may be payable under proposed population-based payment models. See Attachment B for a preliminary list of services included in the population-based payment model.

3.2.5 Applicants must describe their plan to refine and recommend quality measures for a value-based payment. See Attachment B for a preliminary list of quality measures.

3.2.6 Applicants must describe their plan to refine and recommend a recipient rewards program for recipients achieving defined health goals.

3.2.7 Applicants must describe their plan to develop policies regarding services that are potentially duplicative of the case management fee. Examples of potentially duplicative services include community health worker services, targeted case management services, and mental health services provided through a collaborate care model.

3.2.8 Applicants must describe their plan to develop the alternative payment methodology. It is anticipated this will include providing multiple model options and developing payment and coverage policies, calculating population-based payments, calculating case management payments, developing a method for updating the payment rates, and developing the value-based payment methodology for achievement or improvement on specified quality measures.

Models should be inclusive of services provided by Federally Qualified Health Centers, Rural Health Centers, and Indian Health Service providers paid at a daily encounter rate. Models must include narrative description of all methodology inputs, provider and recipient incentives, and estimated fiscal impacts for each participating provider and the overall impact to the project budget.

See Attachment B regarding an overview of the preliminary model concept.

3.2.9 Applicant must describe their plan to assist with identifying the best federal authority for the model and assist with drafting a state plan amendment or 1115 demonstration application.

3.3 Project Management

3.3.1 Applicants must include a preliminary project work plan that describes the technical approach and steps to be taken in partnership with the Division of Medical Services for the duration of the contract period. The Division of Medical Services requires the rate modeling and final recommendation to be presented on or before January 1, 2027.

3.3.2 Applicants must include a project management plan inclusive of regular, periodic project status reports and recommended intervals for those discussions.

3.3.3 Applicants must propose how they intend to share data, reports, and other information such as utilization of a vendor provided portal, dashboard, or SharePoint equivalent. The State typically prefers to utilize its licensed SharePoint or Teams site but will discuss as needed with the selected vendor.

3.3.4 Applicants must describe their ability and proven history handling special project constraints.

3.3.5 Applicants must describe their resources available to perform the work, including any specialized services, within the specified time limits of this project.

3.3.6 Applicants must describe their plan for conducting and facilitating stakeholder engagement meetings and providing financial modeling and technical assistance to providers.

3.4 Additional Proposal Requirements

3.4.1 Proposals must include names, resumes, and specializes expertise of key project staff.

Preference for payment modeling may be given to vendors utilizing an actuary to calculate the population-based payments.

3.4.2 Proposal must include a record of the vendor’s past performance, including price and cost data from previous projects, quality of work, ability to meet schedules, cost control and contract administration.

4.0 PROPOSAL REQUIREMENTS AND COMPANY QUALIFICATIONS

4.1 The offeror is cautioned that it is the offeror's sole responsibility to submit information related to the evaluation categories and that the State of South Dakota is under no obligation to solicit such information if it is not included with the proposal. The offeror's failure to submit such information may cause an adverse impact on the evaluation of the proposal.

4.2 Offeror's Contacts: Offerors and their agents (including subcontractors, employees, consultants, or anyone else acting on their behalf) must direct all of their questions or comments regarding the RFP, the evaluation, etc. to the buyer of record indicated on the first page of this RFP. Offerors and their agents may not contact any state employee other than the buyer of record regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and/or exclusion from specific procurements. Offerors and their agents who have questions regarding this matter should contact the buyer of record.

4.3 Provide the following information related to at least three previous and current service/contracts, performed by the offeror’s organization, which are similar to the requirements of this RFP.

4.3.1 Name, address and telephone number of client/contracting agency and a representative of that agency who may be contacted for verification of all information submitted;

4.3.2 Dates of the service/contract; and

4.3.3 A brief, written description of the specific prior services performed and requirements thereof.

4.4 The offeror may be required to submit a copy of their most recent independently audited financial statements.

4.5 If an offerors proposal is not accepted by the State, the proposal will not be reviewed/evaluated. Examples include: Proposal was not received on time. Proposal was not signed. Electronic file was not provided.

5.0 PROPOSAL RESPONSE FORMAT

5.1 Only a PDF copy shall be submitted via SFTP folder.

5.1.1 The proposal should be page numbered and should have an index and/or a table of contents referencing the appropriate page number.

5.2 All proposals must be organized and tabbed with labels for the following headings:

5.2.1 RFP Form. The State’s Request for Proposal form (1st page of RFP) completed and signed.

5.2.2 Executive Summary. The one-to-two-page executive summary is to briefly describe the offeror's proposal. This summary should highlight the major features of the proposal. It must indicate any requirements that cannot be met by the offeror. The reader should be able to determine the essence of the proposal by reading the executive summary. Proprietary information requests should be identified in this section.

5.2.3 Detailed Response. This section should constitute the major portion of the proposal and must contain at least the following information:

5.2.3.1 A complete narrative of the offeror's assessment of the work to be performed, the offeror’s ability and approach, and the resources necessary to fulfill the requirements.

This should demonstrate the offeror's understanding of the desired overall performance expectations.

5.2.3.2 A specific point-by-point response, in the order listed, to each requirement in the RFP.

The response should identify each requirement being addressed as enumerated in the

RFP.

5.2.3.3 A clear description of any options or alternatives proposed.

5.2.4 Cost Proposal. Cost will be evaluated independently from the technical proposal. Offerors may submit multiple cost proposals. All costs related to the provision of the required services must be included in each cost proposal offered.

See section 7.0 for more information related to the cost proposal.

5.3 Disclosure of RHT Funding (2 pages or less single spaced)

5.3.1 Disclose any other RHT funding applied for with the state of South Dakota and any potential duplication between this application and other funding.

5.3.2 Disclose any other RHT funding applied for with another state and any potential duplication between this application and other funding.

6.0 PROPOSAL EVALUATION AND AWARD PROCESS

6.1 After determining that a proposal satisfies the mandatory requirements stated in the Request for Proposal, the evaluator(s) shall use subjective judgment in conducting a comparative assessment of the proposal by considering each of the following criteria:

6.1.1 Specialized expertise, capabilities, and technical competence as demonstrated by the proposed approach and methodology to meet the project requirements;

6.1.2 Resources available to perform the work, including any specialized services, within the specified time limits for the project;

6.1.3 Record of past performance, including price and cost data from previous projects, quality of work, ability to meet schedules, cost control, and contract administration;

6.1.4 Proposed project management techniques;

6.1.5 Availability to the project locale;

6.1.6 Familiarity with the project locale; and

6.1.7 Ability and proven history in handling special project constraints;

6.1.8 Cost proposal.

6.2 Experience and reliability of the offeror's organization are considered subjectively in the evaluation process.

Therefore, the offeror is advised to submit any information which documents successful and reliable experience in past performances, especially those performances related to the requirements of this RFP.

6.3 The qualifications of the personnel proposed by the offeror to perform the requirements of this RFP, whether from the offeror's organization or from a proposed subcontractor, will be subjectively evaluated. Therefore, the offeror should submit detailed information related to the experience and qualifications, including education and training, of proposed personnel.

6.4 The State reserves the right to reject any or all proposals, waive technicalities, and make award(s) as deemed to be in the best interest of the State of South Dakota.

6.5 Award: The requesting agency and the highest ranked offeror shall mutually discuss and refine the scope of services for the project and shall negotiate terms, including compensation and performance schedule.

6.5.1 If the agency and the highest ranked offeror are unable for any reason to negotiate a contract at a compensation level that is reasonable and fair to the agency, the agency shall, either orally or in writing, terminate negotiations with the contractor. The agency may then negotiate with the next highest ranked contractor.

6.5.2 The negotiation process may continue through successive offerors, according to agency ranking, until an agreement is reached or the agency terminates the contracting process.

6.5.3 Only the response of the vendor awarded work becomes public. Responses to work orders for vendors not selected and the evaluation criteria and scoring for all proposals are not public.

Vendors may submit a redacted copy with the full proposal as stated in Section 1.12 Proprietary Information. SDCL 1-27-1.5 and See SDCL 1-27-1.5 and 1-27-1.6.

7.0 COST PROPOSAL

7.1 Cost will be evaluated independently from the technical proposal.

7.2 Applicants are encouraged to submit a time-based cost proposal with associated hourly rates. All costs related to the provision of the required services must be included in the cost proposal.

7.3 Applicants must provide a budget for services and expenses needed for the completion of the Scope of Work as described in Section 3.0.

7.4 Cost proposals must breakout costs related to subject matter expert(s) professional services time, conference call time, and travel expenses.

Attachment B – Preliminary Model Information The following provides preliminary information about the model concept, which the vendor will help refine and further develop.

Preliminary Model Concept Overview

The table below provides an overview of the preliminary model concept. The vendor will help refine this concept.

Population Healthy – Prevention Focused Recipients

Single Chronic Condition

– Early Intervention Focused Recipients

Multiple Chronic Condition – Care Coordination Focused Recipients

Primary Care Services Payments Options

1. Entirely Fee for Service

1. Entirely Fee for Service

1. Entirely Fee for Service

2. Primary Care prospective population-based payment for select services. Payment amounts depend on recipient tiering by age.

2. Primary Care prospective population-based payment for select services. Payment amounts depend on recipient tiering by acuity.

2. Primary Care prospective population-based payment for select services. Payment amounts depend on recipient tiering by acuity.

Case Management Payments

No additional case management payment.

Case management payment depends on use of provider employed case manager or shared case manager.

Case management payment depends on use of provider employed case manager or shared case manager.

Quality of Care Payments

Provider quality incentive payment available. Patient incentive payment is not applicable.

Provider and patient incentive payments are available.

Provider and patient incentive payments are available.

Preliminary Procedure Code List

The following is a preliminary list of procedure codes included in the population-based payment. The vendor will help refine this code list.

Synchronous audio-only visits for evaluation and management of established patient;

Office or other outpatient visit for evaluation and management of new or established patient;

Home or resident visit for evaluation and management of new or established patient;

Initial and period comprehensive preventative medicine evaluation and management services;

Prolonged clinical staff service during an evaluation and management service with direct patient contact; and

Prolonged outpatient evaluation and management service with or without direct patient contact.

Preliminary Quality Measure List

The following is a preliminary list of quality measures included in the model. The vendor will help refine this measure list.

Well-Child Visits in the First 30 Months of Life (W30-CH)

Child and Adolescent Well-Care Visits (WCV-CH)

Screening for Depression and Follow-Up Plan: Age 12 and Older (CDF-CH and CDF-AD)

ED Visits per 1,000 Member Months (AMB-CH and Adult)

Breast Cancer Screening (BCS-AD)

Colorectal Cancer Screening (COL-AD)

Controlling High Blood Pressure (CBP-AD)

Glycemic Status Assessment for Patients with Diabetes (GSD-AD)