Medicaid managed care rate setting/program admin

The State of West Virginia Department of Administration Purchasing Division, on behalf of the Department of Human Services Bureau for Medical Services (BMS), is requesting proposals for Medicaid Managed Care Rate Setting, Program Administration, and Actuarial Services under CRFP 0511 BMS2700000001, with proposals due August 25, 2026 at 1:30 p.m. ET and vendor questions due July 30, 2026. The solicitation is structured as a dual procurement: one for state-level funding (evaluated with West Virginia reciprocal vendor preference under W. Va. Code 5A-3-37(b), applied equally to resident and certified non-resident small, women-owned, or minority-owned businesses) and one for county/local federal funding (evaluated without vendor preferences). Award may result in a single combined contract or multiple contract awards depending on evaluation outcomes.

The scope comprises lead actuary services (5,000 hours annually), staff actuary services (20,000 hours annually), technical support staff (5,000 hours annually), clerical support staff (5,000 hours annually), managed care program oversight services (annual fixed amount), managed care oversight ad hoc services (5,000 hours annually), actuarial services ad hoc services (5,000 hours annually), financial services (annual fixed amount), and optional rate-setting services (annual fixed amount). The vendor may subcontract for actuarial services only; all other services must be performed by the prime contractor. Offerors must submit a Conflict Mitigation Plan addressing potential conflicts between MLR audit functions and rate-setting activities, evaluated as a scored technical criterion. Mandatory Project Requirements are evaluated on a pass/fail basis before technical scoring is applied.

The contract includes a base year plus five optional renewal years (through 2031). Pricing is structured on hourly rates for labor positions and fixed annual amounts for program oversight, financial services, and rate-setting services, all-inclusive of general and administrative expenses, travel, training, and supplies. Contract payments are made monthly in arrears; ad hoc service payments are based on approved statements of work. The Service Level Agreement imposes a $500-per-day deduction for each day any deliverable remains unfulfilled beyond the agreed deadline. Proposals must be submitted in hard copy with one original technical proposal and one original cost proposal, each sealed separately, to 2019 Washington Street East, Charleston, WV 25305. Deliveries occur at 350 Capitol Street, Room 251, Charleston, WV 25301-3709. Prior to award, the successful vendor must register with the West Virginia Purchasing Division and pay the $125 registration fee.