Actuarial Services C5903

The Commonwealth of Kentucky, Cabinet for Health and Family Services, Department for Medicaid Services, Division of Fiscal Management is soliciting a single contractor to provide comprehensive actuarial services under RFP 746 2600000110, with proposals due by May 14, 2026, at 2:00 PM Eastern Time. The procurement encompasses managed care organization (MCO) rate development, risk adjustment analysis using the Chronic Illness and Disability Payment System (CDPS) + Rx model with ICD-10 diagnosis codes, Non-Emergency Medical Transportation (NEMT) rate certification, budget forecasting services, medical loss ratio adjustments, directed payment calculations, encounter data monitoring, and additional financial analysis activities. Key deliverables include project work plans, MCO rates and databooks with CMS Rate Setting Checklists, risk-adjusted rates and certifications with specific submission deadlines (September 5, December 5, March 5, and June 5 at 5 PM EST), value-based payment plan benchmarks, NEMT rates and databooks, directed payment analyses and reconciliations, budget forecasting projections, encounter data monitoring reports, and fiscal impact analyses. The initial contract term runs from July 1, 2026, through June 30, 2028, with renewal options for up to two additional two-year periods. Contractor minimum requirements include five years of business establishment, three years of Medicaid actuarial experience, fellowship in recognized actuarial societies, knowledge of managed care rate setting and related actuarial functions, professional liability insurance of $1,000,000 per claim, commercial general liability insurance of $1,000,000 per occurrence with $2,000,000 aggregate, and cyber insurance or performance bond covering data breach liabilities. Evaluation criteria consists of technical proposals worth 1,850 points, cost proposals worth 800 points, and optional oral presentations worth 200 points, with a maximum of 2,850 possible points; proposals scoring below 1,080 points on technical evaluation are eliminated. Written questions were due by April 13, 2026, with Commonwealth responses provided by April 23, 2026. Performance-based penalties for late deliverables range from $100 to $1,000 per business day depending on deliverable type, with MCO and NEMT rates incurring the highest penalties at $1,000 per day.

The RFP does not specify set-aside designations or restrictions on organizational types able to respond, indicating this is an open competitive procurement. The incumbent contractor paid $3,461,972.05 for actuarial services in State Fiscal Year 2025, providing a reference point for expected contract value. The contractor must integrate with Kentucky's existing Medicaid infrastructure, including services to five MCOs operating under 1915(b) waivers across two medical regions established as of State Fiscal Year 19, and must comply with the state's approved risk adjustment model and CMS compliance requirements outlined in the 1915(b) Waiver approval for the Human Service Transportation Delivery Program (CMS control number KY-0006.R05.00), effective April 1, 2025, through March 31, 2027. The contractor must maintain budget neutrality in rate calculations, incorporate state-directed payments for state hospitals and HB320 requirements, and validate underlying utilization counts for consistency with actual payment methodologies. The contract is subject to extensive federal compliance requirements under 2 CFR Part 200, including domestic preference provisions, debarment certifications, and cybersecurity requirements with annual penetration testing. Invoicing must follow the Legislative Research Commission's Government Contract Review Committee form with supporting documentation broken down by project name and personnel hours, and all contract effectiveness is contingent upon approval by the Secretary of the Finance and Administration Cabinet and filing with the Legislative Research Commission's Government Contract Review Committee.