ODMR 2627-0005 Provider Reimbursement Technical Assistance

The Ohio Department of Medicaid (ODM) issued Request for Competitive Sealed Proposals ODMR 2627-0005 to procure a qualified consulting firm to provide Provider Reimbursement Technical Assistance services supporting Medicaid healthcare transformation initiatives. The scope of work encompasses inpatient and outpatient hospital service rebasing under APR-DRG and EAPG grouper methodologies, cost-coverage add-on monitoring, non-institutional service examination, ambulatory surgical center rate setting, potentially preventable readmission reporting, fiscal impact analysis of budget initiatives, and federal stakeholder coordination with the Centers for Medicare and Medicaid Services (CMS). Required deliverables include calculating rebased rates, developing cost coverage reports, analyzing claims and cost report data, producing regulatory impact analyses, facilitating stakeholder negotiations, and drafting responses to CMS inquiries. Key personnel requirements include a Lead Medicaid Healthcare Business Expert with seven years of Medicaid delivery system experience, a Healthcare Business Manager with five years of large-scale project management experience, at least two Regulatory Analysts with five years of waiver analysis experience, at least two Financial and Budget Analysts with five years of Medicaid change analysis experience, and additional specialists, researchers, and junior staff as specified. Proposals are evaluated on 325 total points: 260 points (80%) for technical merit across 26 weighted evaluation criteria and 65 points (20%) for cost, with an additional 10 points available for submitting no exceptions to standard terms and conditions; proposals must achieve a minimum of 156 points on technical evaluation to advance to cost proposal scoring. The Q&A period runs from February 17, 2026 through March 4, 2026 at 4:00 PM EST, with proposals due by March 19, 2026 at 4:00 PM EST, contract award notification estimated for June 1, 2026, and implementation anticipated for June 2026.

This procurement includes a mandatory 15% minimum subcontracting requirement for Ohio-certified Minority Business Enterprises (MBEs), with additional preference points available for Veteran-Friendly Business Enterprises (VFBEs); the contract template specifies that a 15% MBE holdback is required on all invoices, with documentation required to demonstrate compliance at each fiscal year-end. The initial contract period extends through June 30, 2027, with two optional two-year renewal periods available through June 30, 2031, contingent upon satisfactory performance, funding availability, and required approvals, and no work may commence prior to purchase order approval by the Ohio Office of Budget and Management. The vendor must comply with HIPAA requirements, data security and privacy standards requiring encryption at rest and in transit, maintenance of data within the contiguous United States across minimum two geographically distant data centers, annual SOC 2 Type 2 audits, confidentiality standards, Americans with Disabilities Act compliance, state ethics laws, and various executive orders. Pricing is structured as a firm-fixed-price agreement based on hourly billable service rates with separate cost proposals required for State Fiscal Years 26 through 31; while the RFP does not specify a total contract value or budget range, the contract template indicates annual allocations will be established upon award based on submitted pricing and scope requirements. The contractor must be prepared to begin work within seven working days of purchase order issuance, and all deliverables, reports, data, and materials produced become the property of ODM with unrestricted rights, though contractors may retain rights to pre-existing proprietary materials upon ODM approval and grant of a perpetual, royalty-free license to the state.