CONTRACT: Medicare Advantage Benefit Administration

The State of New Hampshire Department of Administrative Services, Division of Risk and Benefits, solicited proposals for Medicare Advantage benefit administration services covering approximately 10,650 Medicare-eligible retirees and dependents nationwide, with proposals due March 30, 2023 at 2:00 PM Eastern Time through ProposalTech. The contract runs January 1, 2024 through December 31, 2026, with an option to extend for up to two additional years.

Bidders may propose either a fully insured Medicare Advantage PPO plan with medical benefits only (MA) or a fully insured Medicare Advantage Prescription Drug plan (MAPD) combining medical and prescription drug coverage. The State requires bidders to duplicate current Medicare retiree plan designs and notify the State of any deviations. Current plan design includes three pharmacy tiers with no separate specialty drug copayment schedule, a 30–31 day supply limit for retail medications, and coverage of over-the-counter drugs and non-Part D medications.

Minimum qualifications include demonstrating CMS Medicare Advantage network adequacy compliance (51% rule), financial stability with independent audits, minimum five years of Medicare Advantage medical and prescription drug group experience, current coverage of at least one group with 10,000 lives, and State of New Hampshire registration in good standing with the Secretary of State. Bidders must be in compliance with Protected Health Information requirements prohibiting transfer of data outside the United States and must adhere to HIPAA, HITECH, and CMS Medicare Advantage contracting requirements.

Evaluation employs four steps: minimum qualifications verification, technical scoring (50 points for MA or 60 points for MAPD), financial scoring (50 points for MA or 60 points for MAPD), and award determination. Financial proposals are scored based on total projected costs for the three-year period, with the lowest-cost proposal receiving full points.

Four vendors submitted proposals: Aetna, Anthem, United Health Care, and Humana. For the Medical Only category, United Health Care scored 115.6, Anthem 96.7, Humana 99.5, and Aetna 92.8. For Medical and Prescription Drug, Aetna scored 97.8, Humana 56.3, United Health Care 48.0, and Anthem 47.1.

Questions were due March 8, 2023, with responses posted by March 15, 2023. Addendum #1 extended the question deadline to March 17, 2023. Addendum #2 provided responses to 104 bidder questions and clarified that in-person meetings with the State were required but finalist meetings were not anticipated. Performance guarantees include annual fees at risk ranging from $10,000 to $100,000 across implementation, member services, claims processing, payment accuracy, and pharmacy mail turnaround metrics. The State indicated willingness to negotiate HIPAA, audit scope, and data security provisions with the selected bidder.