HMO Services for MPSERS

The Michigan Department of Technology, Management and Budget issued Request for Proposal No. 230000003226 on October 20, 2023, seeking Health Maintenance Organization (HMO) services for the Michigan Public School Employees' Retirement System (MPSERS), with proposals due November 14, 2023, at 1:00 p.m. Eastern Time. This procurement seeks fully-insured medical and prescription drug coverage administration and claims processing for approximately 35,500 HMO members, including non-Medicare-eligible and Medicare-eligible retirees, beneficiaries, COBRA participants, and their dependents. Contractors must provide comprehensive hospital, emergency, surgical, office visit, preventive, mental health, substance use disorder, durable medical equipment, hearing care, and prescription drug benefits with actuarial equivalence to MPSERS' self-funded plan benchmarks as detailed in Schedules I1 through I4 and Schedule L. Required qualifications include Michigan licensure as an HMO, NCQA accreditation, current CMS Medicare Advantage contracts, and the ability to provide US-based customer service with staff physically located in the United States, preferably Michigan, available Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. Key deliverables include detailed implementation plans, Service Level Agreement compliance reporting, SOC 1 Type 2 and SOC 2 Type 2 audits, HIPAA compliance attestations, HIPAA 834 enrollment files processed weekly, claims and enrollment reporting, actuarial benefit attestations, and performance evaluation survey participation with a required composite score of 4.00 or higher. The contract begins June 1, 2024, with service commencement on January 1, 2025; the contract term is one year with four optional one-year renewal periods, with no payment during the implementation period and pricing firm for the entire contract term not exceeding state-provided premium rates outlined in Schedule B, with non-Medicare rates of $770.67 for self-only, $638.55 for spouse, and $204.46 per child, and Medicare rates of $39.96 for self-only, $36.13 for spouse, and $35.61 per child.

The RFP does not identify set-aside designations or restrictions limiting response by disadvantaged enterprises, though bidders must be licensed Michigan HMOs with demonstrated NCQA accreditation and active Medicare Advantage contracts with the Centers for Medicare and Medicaid Services. Historical data indicates two incumbent HMO contractors currently serving MPSERS, with HMO 1 maintaining approximately 5,200 to 5,800 Medicare enrollees and 3,400 to 3,700 non-Medicare enrollees, while HMO 2 served approximately 22,200 to 23,300 Medicare enrollees and 3,000 to 4,100 non-Medicare enrollees during the March 2021 through March 2023 baseline period. The state reserves the right to conduct site visits, require oral presentations, and perform background checks on contractor personnel, and will evaluate all bidders determined as "Passing" per the evaluation criteria for award consideration. Proposed solutions must address specific technical infrastructure requirements detailed in Schedule N Section 2, including data center locations, cloud or on-premise hosting arrangements, mobile responsiveness, scalability, and system performance capabilities. Award value is not explicitly specified in the available documentation, though bidders must adhere to Schedule B premium pricing structures with rates varying by coverage category and Medicare eligibility status, and must submit pricing in a format separate from other proposal documents with firm pricing for the entire contract term.