Actuarial Services

The State of Nevada, specifically the Department of Health and Human Services Division of Health Care Financing and Policy, is soliciting actuarial services through Request for Proposal (RFP) 40DHHS-S3339 for Nevada Medicaid. The procurement seeks multiple vendors to provide three distinct actuarial service contracts: Managed Care Organization (MCO) and Dental Benefits Administrator (DBA) Capitation Rate Setting, Specialty MCO for Children with Complex Behavioral Health Needs, and Non-Emergency Medical Transportation (NEMT) Rate Setting. Key deliverables include developing annual rate methodologies, performing risk adjustments, analyzing encounter data, reviewing Medical Loss Ratio reports, and supporting rate negotiations for Nevada Medicaid and Nevada Check-Up populations covering approximately 793,904 participants. Vendors must possess actuarial credentials and demonstrate compliance with federal regulations like 42 CFR 438. The solicitation requires comprehensive technical proposals weighted 85% and cost proposals weighted 10%, with potential vendor presentations influencing selection. Critical submission deadlines include July 8, 2025 at 2:00 PM PST for proposal submissions, with an anticipated contract award on September 9, 2025 and a contract start date upon Board of Examiners approval.

The RFP does not explicitly indicate specific set-aside designations or restrictions for disadvantaged enterprises. The contract will have a five-year term with potential two-year extensions, initially covering Calendar Year 2027 and potentially expanding Medicaid managed care statewide to include 75,000 rural residents. While specific budget ranges are not definitively stated, the cost schedule includes provisions for a resource pool of actuarial and financial vendors with hourly rate structures for different professional levels, including Principals, Managing Actuaries, Consulting Actuaries, Actuarial Analysts, and Support Staff. The state intends to award contracts to multiple vendors based on their expertise in Medicaid rate setting, federal compliance, and ability to support evolving program requirements. Vendors will be part of a resource pool for ad-hoc reporting and services, with work initiated through a state-defined work order process and compensation based on completed deliverables. The procurement emphasizes developing actuarially sound capitation rates and supporting innovative healthcare financing initiatives for Nevada's Medicaid program.