Health Home Performance Analysis
Closed State & local contract opportunity Posted
- Solicitation number
- 26RFP19620
- State
- South Dakota
- Responses due
Opportunity facts
- Jurisdiction
Opportunity details come from postingboard.esmsolutions.com. Updated .
About this opportunity
The South Dakota Department of Social Services, Division of Medical Services, is issuing a Request for Proposal (RFP19620) to procure vendor services for comprehensive financial outcomes and quality outcomes analysis of the South Dakota Medicaid Health Home program, which operates under the name Care Connect. The selected vendor will be responsible for developing and implementing detailed methodologies to analyze financial outcomes and quantify cost savings or cost avoidance related to the program's six core services: Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care/Follow-up, Patient and Family Support, and Referral to Community and Social Support Services. The vendor must also accept, aggregate, and analyze health outcome measures data submitted by providers serving eligible Medicaid recipients with chronic conditions or serious mental illness. Key evaluation criteria include specialized expertise in health program analysis, available resources, record of past performance, cost proposal competitiveness, availability and familiarity with South Dakota, project management capabilities, and ability to handle project constraints. Critical dates include a non-binding Letter of Intent due by March 10, 2026, offeror questions due by March 17, 2026 with State responses by March 24, 2026, SFTP folder access requests due by April 7, 2026, and final proposal submissions due by April 8, 2026 at 5:00 pm CST. The State anticipates an award decision by April 29, 2026, with oral presentations required at the offeror's expense at the State's discretion.
The RFP does not specify set-aside designations or restrictions on organizational types eligible to respond based on the provided documentation. No incumbent vendors or current contractors are identified in the available materials. The contract will be issued for an initial one-year term ending May 31, 2027, with an option for renewal for up to four additional one-year terms contingent upon performance evaluation and funding availability. Offerors must submit cost proposals using either a deliverable-based or time-based structure with associated hourly rates and defined tasks; however, the RFP does not specify a total contract amount, as compensation will be negotiated with the selected vendor. All vendors must maintain required insurance coverage throughout the contract term, including Commercial General Liability of $1,000,000 per occurrence, Professional Liability of $1,000,000, Business Automobile Liability of $1,000,000, and Workers' Compensation as required by South Dakota law. The contract is contingent upon continued legislative appropriation and availability of funds, with either party permitted to terminate upon 30 days' written notice.
Opportunity text
PURPOSE OF REQUEST FOR PROPOSAL (RFP) South Dakota is seeking a vendor to coordinate and conduct both financial outcomes and quality outcomes analysis of the South Dakota Medicaid Health Home (now operating as Care Connect) program.
Work associated with this RFP will include: • Conducting the financial outcomes analysis to determine potential cost avoidance/cost savings related to Health Home core services; and • Conducting quality outcomes analysis including both collecting and analyzing data from providers.
Background The South Dakota Department of Social Services (DSS) is the state agency responsible for the administration of the Health Homes Program. The program is approved under 1945A authority and effective January 1, 2026 operates under the name Care Connect. The Health Homes Program is a person-centered system of care intended to achieve improved health outcomes and experience of care for eligible Medicaid recipients and maintain at least budget neutrality for specified "High-Cost/High-Risk" Medicaid populations.
There are six Core Services provided by the South Dakota Medicaid Health Homes Program: • Comprehensive Care Management • Care Coordination • Health Promotion • Comprehensive Transitional Care/Follow-up • Patient and Family Support • Referral to Community and Social Support Services
To qualify for enrollment in the Health Homes program, Medicaid recipients must: • Have two or more chronic conditions or one chronic condition and be at risk for another condition. o Chronic Conditions Include: Asthma, COPD, Diabetes, Heart Disease, Hypertension, Substance Abuse, Obesity, Musculoskeletal and Neck/Back disorders. o At-Risk Conditions Include: Pre-Diabetes, Tobacco Use, Cancer Hypercholesterolemia, Depression and Use of Multiple Medications (6 or More Classes of Drugs). • Have a single occurrence of a diagnosis for Severe Mental Illness or Emotional Disturbance, limited to: Schizophrenia, Bipolar, Major Depression, Mood Disorders, Ethyl Alcohol-Related Psychotic Disorder, Anxiety, Personality/Social Disorders, Attention Deficit Hyperactivity Disorder
The designated Health Homes Program provider infrastructure is as follows: Physicians, Advanced Practice Nurses, Physician Assistants working in a Clinical Group Practices, Rural Health Clinics, Federally Qualified Health Centers (FQHCs) or Indian Health Service/Tribal 638 or a Mental Health Professional working in a Community Mental Health Center.
The payment methodology for the Health Homes Program are based upon four Tiers. Each tier has an individual per member, per month (PMPM) payment for provision of the six core Health Homes services. Eligible Medicaid recipients are placed into one of four tiers based upon the prospective risk score determined by the Chronic Illness and Disability Payment System (CDPS). The CDPS score is based on historical claims and diagnoses information normed against the Medicaid population. Those in tier 1 account for approximately half of the eligible population. Tier 1 recipients have a normal prospective risk and, therefore, must opt-in to participate in the Health Homes Program. Tiers 2 through 4 see progressively higher risks of health care utilization and are automatically placed in the Health Home Program but may opt-out of the Health Homes Program.
DSS has an established set of outcome measures that each health home must report on for everyone who received a core service on a bi-annual schedule. These measures include the standard measures required by CMS.
Please refer to the Department of Social Services website link https://dss.sd.gov/healthhome/providers.aspx for additional information regarding the Health Homes Program.
Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after the date and time indicated in the Schedule of Activities. Inquiries must be emailed to Kirsten Blachford at Kirsten.Blachford@state.sd.us with the subject line "RFP19620". The State will respond to offeror's inquiries (if required) via e-mail. In addition, all inquiries and the State's responses will be posted on the state's e-procurement system and the DSS website at http://dss.sd.gov/keyresources/rfp.aspx. Offerors may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP.
Files
| File | Type | Posted |
|---|---|---|
| Response to Offeror Questions document.pdf | ||
| RFP Document.pdf | ||
| RFP Document.pdf |
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