Medicaid Medical Coordination- Aged Blind & Disabl

The Georgia Department of Community Health issued an RFP for a Medicaid Medical Coordination Program serving approximately 466,000 eligible aged, blind, and disabled members in the state's Fee-for-Service system, with proposals originally due February 27, 2014—but the solicitation was cancelled on June 6, 2014 at 1:00 p.m. because received proposals exceeded the available budget.

The scope comprised core coordination services (centralized call center, 24-hour nurse hotline, care coordinators, member education) available to all eligible members, plus intensive medical coordination services (health risk assessments, interdisciplinary care teams, medical home establishment, care management) for a high-risk, impactable population initially representing 10% of members. Eligible members included those dually enrolled with Medicare, enrolled in Home- and Community-Based Services waivers, and those in long-term care institutions.

Compensation was structured on a Per Member Per Month basis with three rate components: core PMPM for coordination, an add-on PMPM for intensive services, and a separate PMPM for case management fees to medical home providers. Offerors were required to bid fixed firm rates for three periods (November 3, 2014–June 30, 2015; July 1, 2015–June 30, 2016; July 1, 2016–June 30, 2017) based on 10% intensive participation and 321,000 average members. The initial contract term ran through June 30, 2015, with four one-year renewal options at DCH discretion. Insurance requirements included $1 million commercial general liability per occurrence, workers' compensation, and $1 million automobile liability; offerors also had to provide an irrevocable letter of credit equal to 10% of annual contract value. Questions were accepted in two rounds (deadlines January 7 and February 4, 2014). DCH reserved the right to audit and adjust payments if performance standards were not met and did not reimburse pre-launch startup, planning, or implementation costs.