Behavioral Health and Substance Use Disorder Benefits Admin

The Michigan Department of Technology, Management and Budget-Procurement is soliciting proposals under RFP No. 260000002410 to administer behavioral health and substance use disorder benefits for State Health Plan PPO enrollees, excluding Medicare Advantage Plan enrollees, with bidder questions due November 10, 2026 and proposals due December 8, 2026 at 1:00 p.m. Eastern. Bidders must hold licensure as a Third-Party Administrator or insurance company in Michigan, and the state requires full implementation of the Plan Sponsor's BH/SUD Plan Design with transparent pass-through pricing that excludes commissions.

The scope is administrative services only for active, retiree, COBRA, and dependent members, with Applied Behavior Analysis case management included in the per-contract-per-month administrative fee. Bidders must reprice FY2024 and FY2025 historical claims (Schedules M1 through M4), complete a network disruption analysis reflecting provider status as of January 1, 2028, and provide telehealth and out-of-network reimbursement methodologies. Integration requires processing ASC X12N 834 enrollment files, including weekly membership change files and discrepancy reports submitted within 48 hours. Hosted services must maintain FedRAMP authorization or annual SSAE 18 SOC 2 Type II audits, store and back up state data exclusively in the continental United States, and meet 99.98% monthly availability. Software response time must be under two seconds for 98% of transactions. The contractor must also execute a HIPAA Business Associate Agreement.

Pricing schedules project approximately 97,300 active members and 19,072 retirees in 2028, rising to 103,226 active members and 20,233 retirees by 2030, and the state does not guarantee minimum or maximum volumes. The contract runs May 1, 2027 through December 31, 2031, with up to seven one-year renewals at the state's sole discretion. Implementation runs July 14, 2027 through December 31, 2027, and operations begin January 1, 2028. Pricing is evaluated over January 1, 2028 through December 31, 2030.

Technical proposals are scored on 100 points across staffing, project management, pricing, service level agreements, data security, plan designs, software capabilities, claims repricing, and network geographic access. Only proposals scoring 80 or more technical points receive pricing evaluation. Awards of $250,000 or more require State Administrative Board approval.

Proposals must be submitted electronically through SIGMA VSS in modifiable formats, with a separate pricing proposal and individual files up to 30 megabytes. Bidders must complete a Confidential Treatment Form and a Vendor Questions Worksheet that includes at least four relevant experience examples from the past five years. Proposals become public record upon receipt. Answers to bidder questions will be posted at www.michigan.gov/SIGMAVSS by November 19, 2026. Solicitation manager Mary Ostrowski can be reached at (517) 249-0438 or ostrowskim@michigan.gov.