Actuarial Services C5903

The Commonwealth of Kentucky's Department for Medicaid Services is soliciting qualified actuarial firms to provide comprehensive actuarial services for the state's Medicaid managed care program under RFP 2600000110 (Actuarial Services C5903). The procurement encompasses managed care organization rate development for approximately 672,000 members across eight medical regions, non-emergency medical transportation rate certification across 15 transportation regions, risk adjustment analysis utilizing the Chronic Illness and Disability Payment System (CDPS) + Rx model, budget forecasting, medical loss ratio calculations, directed payment reconciliation, encounter data monitoring, and additional financial analysis activities. Key deliverables include annual MCO rates and databooks due September 1 (draft) and September 30 (final) with $1,000 per business day penalties for late submission; NEMT rates due February 1 (draft) and February 15 (final) with identical penalties; quarterly risk adjustment analyses with $500 per business day penalties; quarterly budget forecasting updates with $250 per business day penalties; and quarterly encounter data monitoring reports with $100 per business day penalties. Vendors must demonstrate a minimum of five years as an established business entity and three years of actuarial experience in Medicaid or managed healthcare with fellowship in the American Academy of Actuaries, Society of Actuaries, or Casualty Actuarial Society. The evaluation criteria allocate 1,850 technical proposal points, 800 cost proposal points, and up to 200 oral presentation points for a maximum total of 2,850 points, with proposals scoring below 1,080 technical points eliminated from consideration. Written questions were due April 13, 2026, with proposals due May 14, 2026, at 2:00 PM Eastern Time. The initial contract term runs from July 1, 2026, through June 30, 2028, with two optional two-year renewal periods subject to Cabinet and Legislative Research Commission approval.

No set-aside designations or disadvantaged enterprise restrictions are identified in the procurement documents. All work must be performed by United States-based personnel, and vendors must maintain professional liability insurance with minimum limits of $1,000,000 per claim and commercial general liability insurance with minimums of $1,000,000 per occurrence and $2,000,000 aggregate, in addition to cyber insurance or performance bonding. The incumbent contractor received $3,461,972.05 in total payments during State Fiscal Year 2025. Vendors must comply with HIPAA and data security requirements, maintain confidentiality of all sensitive Medicaid data, and implement comprehensive business continuity and disaster recovery plans. The contract is subject to approval by the Finance and Administration Cabinet and the Legislative Research Commission Government Contract Review Committee before becoming effective, with all contracts governed by federal regulations including 2 CFR Part 200 and various Kentucky statutes governing tax, employment, and ethics compliance.