Health INS case MGT SVC

The State of South Carolina, specifically the Department of Health and Environmental Control (DHEC), is procuring Health Insurance Case Management Services through RFP 5400022040 for two specialized programs targeting adults 18 and older without existing insurance coverage: the Hemophilia and Sickle Cell programs. The primary services include accepting client referrals, making initial contact within 24 hours, assisting with insurance plan selection and enrollment, and providing comprehensive case management through follow-up protocols at days 7, 14, 21, and 30. Key deliverables encompass ongoing client monitoring, expense tracking, quarterly reporting on activity metrics, and maintaining detailed case file documentation. Contractors must demonstrate the ability to manage specified caseloads while ensuring compliance with state and federal health insurance administration regulations. The original proposal submission deadline was October 21, 2021, at 2:30 PM ET, with the initial award posting scheduled for November 2, 2021, though subsequent documents indicate an extension of the award posting date. Evaluation criteria are anticipated to include cost competitiveness, contractor experience, staff qualifications, and demonstrated capacity to effectively manage the required caseload.

While no specific set-aside designations are explicitly mentioned, the procurement appears open to qualified vendors capable of meeting the program's stringent requirements. The contract includes maximum annual budget caps of $500,000 for the Hemophilia program and $150,000 for the Sickle Cell program, with strict limitations on individual client premium assistance and out-of-pocket expenses. For Hemophilia clients, the maximum annual premium assistance is capped at $15,000 with a $10,000 out-of-pocket expense limit, while Sickle Cell clients have a $7,500 annual premium assistance and $8,000 out-of-pocket expense maximum. No specific case management credentials are mandated, though vendors must adhere to defined client contact and monitoring protocols. The documents suggest an incumbent vendor is currently providing these services, indicating this might be a competitive rebid situation. The contract will be awarded to the vendor offering the best overall value to the State, with DHEC retaining responsibility for final program enrollment despite the case management contractor's assistance in plan selection.