Prepaid Inpatient Health Plan (PIHP) RFP

The Michigan Department of Health and Human Services (MDHHS) is seeking proposals for a Prepaid Inpatient Health Plan (PIHP) contract to manage Medicaid specialty behavioral health services across three regions: Northern, Central, and Metro. The procurement, identified as RFP 250000002670, aims to provide comprehensive mental health, developmental disabilities, and substance use disorder services for Medicaid beneficiaries under the 1115 Behavioral Health Demonstration Waiver and Healthy Michigan Plan. Bidders must demonstrate capabilities in network management, care coordination, provider enrollment, and comprehensive reporting, with a focus on four strategic pillars: delivering high-quality timely services, improving choice and consistency, ensuring accountability and transparency, and simplifying the system. The RFP requires contractors to submit detailed narrative responses addressing 19 specific questions covering network adequacy, care coordination, cultural competence, emergency interventions, and data analysis. Key evaluation criteria include the quality of proposed services, compliance with state and federal regulations, and the ability to serve diverse populations. Critical dates include an RFP issue date of August 4, 2025, a bidder's conference on August 11, 2025, and a proposal deadline of September 29, 2025, with an anticipated contract signing on February 24, 2026, and services beginning October 1, 2026.

The procurement is open to nonprofit organizations, public bodies/governmental entities, and public universities, with no specific set-aside designations mentioned. Bidders must be prepared to manage services for various beneficiary groups, including children's waiver programs, serious emotional disturbance waivers, and habilitation supports waivers. The contract will be funded through capitated payments calculated on a per-eligible-per-month (PEPM) methodology, with potential performance incentive mechanisms including a 0.75% to 2% performance withhold that can be earned back based on quality metrics. While specific incumbent vendors are not explicitly identified, the RFP indicates that contractors must integrate with existing Medicaid Health Plan infrastructure and comply with extensive reporting requirements. The funding projection for the Certified Community Behavioral Health Clinic (CCBHC) Demonstration ranges from $328.6 million in State Fiscal Year 2023 to $654.6 million, with the Central and Metro regions receiving the majority of funding. Contractors will be subject to a risk corridor mechanism where they bear full financial risk for the first 2% deviation from the target medical loss ratio and share gains/losses between 2-7% deviation.