Medicaid clinical data exchange

The South Carolina Department of Health and Human Services is requesting proposals for a Medicaid Clinical Data Exchange system to capture and route admission, discharge, and transfer (ADT) events and bed status data from acute care hospitals and licensed facilities to five contracted Managed Care Organizations and SCDHHS, with proposals due October 15, 2026 and anticipated award on February 23, 2027.

The non-mandatory pre-proposal conference is scheduled for August 21, 2026 at 10:00 AM EST via Microsoft Teams; questions are due August 25, 2026 at 12:00 PM EST. The contract term begins March 5, 2027 and extends through March 4, 2034, comprising a four-year base period plus three optional one-year renewals. The implementation period is approximately one year, with six years of operations and maintenance following. All work must be performed within the United States with no offshore contracting permitted.

The scope encompasses platform development and implementation to capture relevant medical visit data, provide comprehensive dashboards and reporting for care coordination and quality monitoring, manage provider enrollment and credentialing, and deliver help desk support and system change management based on regulatory requirements. The contractor must identify key personnel by name, including Account Manager, Project Manager, Operations Manager, Deployment Manager, Functional Leads, and Technical/Test Managers. Monthly data quality reporting is required, and the contractor is responsible for onboarding facilities and maintaining monthly member counts estimated at 438,968 across contract years.

Pricing is fixed-price with separate cost components for implementation, ADT operations (calculated per member monthly plus onboarding costs), Bed Status operations (fixed monthly cost), and a modification pool capped at $2.5 million for scope changes approved by SCDHHS. Vendors must submit a rate card identifying hourly rates for various roles to support potential scope changes.

Offerors must complete a Service Provider Security Assessment Questionnaire addressing twelve security dimensions, obtain a state vendor number, comply with mandatory certifications including debarment and drug-free workplace, and disclose organizational conflicts of interest. AI/ML solutions must comply with NIST AI Risk Management Framework, fully disclose all AI/ML uses, ensure human review and override for decisions affecting eligibility or benefits, and prohibit use of SCDHHS Protected Health Information for model training without written authorization. Proposals require both technical and business components; evaluation criteria emphasize technical proposal factors and price, with award made to the single most responsive and responsible offeror.