Schedule B Pricing.xlsx
XLSX spreadsheet 28 KB Posted
- Solicitation number
- RFP 171 260000002410 2
- Issued by
- Michigan
About this file
This is a Schedule B Pricing document for Michigan's Request for Proposal No. 260000002410, which solicits administrative services for Behavioral Health and Substance Abuse Benefits under the State Health Plan PPO. Contractors are required to submit pricing proposals for a three-year contract period commencing January 1, 2028, and ending December 31, 2030. The pricing schedule must be completed in modifiable format (Microsoft Word or Excel), with only light blue-shaded cells populated by bidders. Contractors must include all costs in their proposals, including one-time setup charges and any fees they may charge the State. The contract covers projected membership of approximately 97,300 active members and 19,072 retirees in 2028, increasing to 103,226 active members and 20,233 retirees by 2030.
Pricing proposals must be submitted on a Per Contract Per Month (PCPM) basis for Administrative Service Only (ASO) fees, inclusive of Applied Behavior Analysis (ABA) case management fees, along with claims cost projections utilizing an 8 percent trend factor. Contractors must reprrice historical claims data from Schedules M1, M2, M3, and M4 (representing active and retiree populations for fiscal years 2024 and 2025) and provide pass-through pricing to the plan sponsor without charging amounts exceeding provider payments. Additional pricing information required includes telehealth reimbursement rates segmented by provider level, out-of-network reimbursement methodologies, shared-savings programs, and average reimbursement levels for both national and Michigan-specific employer book of business by CPT code and provider type. Bidders are encouraged to offer quick payment discount terms. Price proposals must certify independent pricing development without consultation or agreement with other contractors. The State of Michigan does not guarantee minimum or maximum service volumes, claims, or conversions under the contract.
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Pricing Matrix
| STATE OF MICHIGAN |
| Request For Proposal No. 260000002410 |
| Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO |
| SCHEDULE B - PRICING |
| 1. The Contractor must provide a pricing schedule for the proposed Contract Activities identified in Schedule A using the tables below. The Contractor must complete only areas shaded in light blue and must not alter data or formulas in cells that are not shaded light blue. |
| 2. The Contractor must also complete repricing for the claims data in Schedules M1, M2, M3 & M4. See also Schedule A Section 1.1.5 and 1.1.11. |
| 3. The pricing schedule should be submitted in a modifiable format (e.g.. Microsoft Word or Excel); however, you may also submit an additional pricing schedule in a non-modifiable format (e.g., PDF). Failure to complete the pricing schedule as requested may result in disqualification of your proposal. |
| 4. Price proposals must include all costs, including but not limited to, any one-time or set-up charges, fees, and potential costs that Contractor may charge the State. |
| 5. The Contractor must provide Pass-Through Pricing to Plan Sponsor. The Contractor must not charge Plan Sponsor or any Member any amount above that which is paid to the Provider under the terms of the contract between the Contractor and the Provider. |
| 6. By submitting its proposal, the Contractor certifies that the prices were arrived at independently, and without consultation, communication, or agreement with any other Contractor. |
| 7. The Contract will be for a 3-Year period with service commencing January 1, 2028, and ending December 31, 2030. For Annual-Rate Pricing, the price quoted each year must be firm for the plan year. |
| Membership Assumptions: | ||||||
| Current Membership is based on recent available data and is subject to change throughout the year and contract. | ||||||
| Contract Type | Active: 2028 Projected | Retiree: 2028 Projected | Active: 2029 Projected | Retiree: 2029 Projected | Active: 2030 Projected | Retiree: 2030 Projected |
| Total Members: | 97,300 | 19,072 | 100,219 | 19,644 | 103,226 | 20,233 |
| Total Contracts: | 37,914 | 9,328 | 39,051 | 9,608 | 40,223 | 9,896 |
| Autism Program (ABA Information) | ||||||
| Summary Units by Member Age Range | ||||||
| Q1 | Q2 | Q3 | Q4 | |||
| 0-6 | Auth Units | |||||
| per Week Avg | 18.7 | 29.3 | 28.6 | 25.0 | ||
| Membership Count | 23 | 21 | 25 | 20 | ||
| 7-12 | Auth Units | |||||
| per Week Avg | 13.7 | 15.5 | 15.3 | 15.4 | ||
| Membership Count | 30 | 33 | 22 | 27 | ||
| 13+ | Auth Units | |||||
| per Week Avg | 11.2 | 16.0 | 16.6 | 15.8 | ||
| Membership Count | 23 | 16 | 17 | 10 |
| Claims Projection from Claims Repricing |
| Instructions: Please enter the Paid Per Contract Per Month (PCPM) from Schedule M1, M2, M3 & M4 (from the Cost Summary tabs cell B12). The membership information above will be used for the calculations. Only the light blue boxes should be populated, and only populated with numeric values. |
For comments, please use the box below this table to enter any explanation of claims that couldn't be repriced, caveats to the pricing quote, or other notes salient to your pricing.
| Schedule M1 Active FY 2024 | Schedule M2 Active FY 2025 | Schedule M1 Retiree FY 2024 | Schedule M2 Retiree FY 2025 | |
| Per Contract Per Month from Claims Repricing |
| Three Year Pricing Proposal: |
| Instructions: Please enter your proposed administrative fees below. Only the light blue boxes should be populated, and only populated with numeric values. |
For comments, please use the box below this table to enter any explanation of claims that couldn't be repriced, caveats to the pricing quote, or other notes salient to your pricing.
| Pricing Option | Plan Year 1 (01/01/2028 - 12/31/2028) | Plan Year 2 (01/01/2029 -12/31/2029) | Plan Year 3 (01/01/2030- 12/31/2030) | Total Cost over 3 Years |
| Self Funded |
Per Contract Per Month (PCPM) - Administrative Service Only (ASO) Fee inclusive of ABA Case fees (1) $ - 0
Claims Cost Projection (Projects average PCPM to each plan year using 8% trend and projected enrollment) (1) $ - 0 $ - 0 $ - 0 $ - 0
Total $ - 0 $ - 0 $ - 0 $ - 0
| Implementation Credit |
| Note: (1) The State of Michigan does not guarantee a minimum or maximum volume of services, claims and conversions. |
| Enter 3 Year Pricing Proposal notes here, including any discussion of claims that couldn't be repriced, etc.: |
The Contractor is encouraged to offer quick payment terms. The number of days must not include processing time for payment to be received by the Contractor's financial institution.
Quick payment terms: ________ % discount off invoice if paid within ________ days after receipt of invoice.
| ADDITIONAL PRICING PROPOSAL INFORMATION: | |||
| Instructions: Provide your Telehealth reimbursement rate segmented by Provider level for Bidder's top three most frequent type of appointments: | |||
| Most Frequent Appointment Type | 2nd Most Frequent Appointment Type | 3rd Most Frequent Appointment Type | |
| MD | |||
| PhD | |||
| Masters Level |
| Instructions: Provide your Book of Business (BOB) utilization rate for telehealth by Provider level and appointment type | |||
| Most Frequent Appointment Type | 2nd Most Frequent Appointment Type | 3rd Most Frequent Appointment Type | |
| MD | |||
| PhD | |||
| Masters Level |
Please describe your out-of-network reimbursement methodology in the space below and expand space if needed:
Please describe any shared-savings programs you have in place with out-of-network providers in the space below if such programs would apply to Plan Sponsor, and expand space if needed:
| Instructions: Indicate average reimbursement levels for your national employer book of business for behavioral health services: | ||||
| CPT Codes | MD | RN | Ph.D. | Master's Level |
| 90791: Psychiatric diagnostic evaluation that includes an integrated assessment of the patient’s history, mental status, and recommendations, without medical services | ||||
| 90792: Psychiatric diagnostic evaluation that includes an integrated assessment of the patient’s history, mental status, and recommendations, with medical services such as a physical examination, medication review, or prescribing | ||||
| 90832: Individual psychotherapy with the patient, approximately 30 minutes in duration | ||||
| 90834: Individual psychotherapy with the patient, approximately 45 minutes in duration | ||||
| 90847: Family psychotherapy conducted with the patient present, including treatment involving the patient and one or more family members | ||||
| 99213: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a low level of medical decision-making; when selected based on time, 20–29 minutes on the date of the encounter | ||||
| 99214: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a moderate level of medical decision-making; when selected based on time, 30–39 minutes on the date of the encounter | ||||
| 99215: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a high level of medical decision-making; when selected based on time, 40–54 minutes on the date of the encounter | ||||
| Instructions: Indicate average reimbursement levels for your Michigan-specific employer book of business for behavioral health services: | ||||
| CPT Codes | MD | RN | Ph.D. | Master's Level |
| 90791: Psychiatric diagnostic evaluation that includes an integrated assessment of the patient’s history, mental status, and recommendations, without medical services | ||||
| 90792: Psychiatric diagnostic evaluation that includes an integrated assessment of the patient’s history, mental status, and recommendations, with medical services such as a physical examination, medication review, or prescribing | ||||
| 90832: Individual psychotherapy with the patient, approximately 30 minutes in duration | ||||
| 90834: Individual psychotherapy with the patient, approximately 45 minutes in duration | ||||
| 90847: Family psychotherapy conducted with the patient present, including treatment involving the patient and one or more family members | ||||
| 99213: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a low level of medical decision-making; when selected based on time, 20–29 minutes on the date of the encounter | ||||
| 99214: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a moderate level of medical decision-making; when selected based on time, 30–39 minutes on the date of the encounter | ||||
| 99215: Office or other outpatient evaluation and management visit for an established patient, requiring a medically appropriate history and/or examination and a high level of medical decision-making; when selected based on time, 40–54 minutes on the date of the encounter |
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