26EHSKWPCMRFR-MassHealth PCA Program PCM Functions RFR

The Executive Office of Health and Human Services (EOHHS) is issuing a Request for Responses to solicit qualified organizations to serve as Personal Care Management (PCM) agencies for the MassHealth Personal Care Attendant (PCA) Program, with responses due June 30, 2026 at 2:00 PM Eastern Time. The RFR anticipates an operational start date of October 1, 2026 and seeks multiple PCM agencies to support approximately 25,000 MassHealth members across the Northeast and Southeast Regions of Massachusetts.

All bidders must comply with the Supplier Diversity Program requirement of a minimum 1% financial commitment to certified diverse business enterprises or nonprofits, with preference given to higher commitments.

PCM functions include intake and orientation, consumer capacity assessments, functional evaluations and re-evaluations, prior authorization submissions, service agreement development, functional skills training, and consumer relations support. Bidders must demonstrate experience supporting individuals with physical disabilities, older adults with personal care needs, and children and youth with personal care needs in a consumer-directed service model. The Model Contract specifies minimum staffing ratios: one full-time equivalent skills trainer per 200 consumers in the first contract year and one trainer per 150 consumers in subsequent years. Key personnel—Contract Manager, Program Director, Registered Nurse, and Skills Training Supervisor—require a minimum of one year of prior equivalent experience. Contractors must comply with 130 CMR 422 regulations, establish quality management systems, conduct criminal background checks on all employees and contractors, and maintain information technology systems capable of managing consumer records and prior authorization tracking.

EOHHS pays PCM agencies an administrative fee on a per-member-per-month basis. In FY 2024, the rate was $58.99 per member per month. The contract term runs through June 30, 2029, with options for up to two additional three-year extensions at EOHHS' sole discretion, subject to legislative appropriations and satisfactory performance.

Bidders must submit detailed cost responses including proposed per-member-per-month fees, one-time startup or software upgrade costs, staffing matrices, and recent Uniform Financial Statements. Responses are evaluated on business qualifications, financial condition, security policies, legal compliance history, organizational overview, background experience, staffing plans, information systems capacity, and geographic service areas. Responses must be submitted electronically via COMMBUYS. Bidders must execute the Model Contract in substantially the same form as provided and comply with Commonwealth Standard Contract Form terms and Commonwealth Terms and Conditions without modification.