Prepaid Inpatient Health Plan (PIHP) RFP

The State of Michigan Department of Health and Human Services (MDHHS) is seeking proposals for a Prepaid Inpatient Health Plan (PIHP) contract to manage specialty behavioral health services across three regions: Northern, Central, and Metro. The procurement, identified as RFP 250000002670, aims to provide comprehensive mental health, substance use disorder, and developmental disability services for Medicaid beneficiaries through the 1115 Behavioral Health Demonstration Waiver Program and Healthy Michigan Plan. Qualified bidders must be nonprofit organizations, public bodies, governmental entities, or public universities capable of delivering services to populations with Serious Mental Illness, Serious Emotional Disturbance, Substance Use Disorder, and Intellectual and Developmental Disabilities. The evaluation process will assess proposals based on a technical scoring system totaling 1,110 points, with proposals scoring 888 or more points eligible for pricing evaluation. Key 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 start date of October 1, 2026. Bidders must demonstrate the ability to operate across entire geographic regions and will be evaluated on factors such as experience, technical capabilities, narrative responses, and overall economic impact to the state.

The RFP includes provisions that may provide preference to qualified disabled veteran and service-disabled veteran-owned businesses during the evaluation process. Bidders must meet specific organizational structure requirements and maintain comprehensive insurance coverage, including Commercial General Liability, Automobile Liability, Workers' Compensation, and Professional Liability insurance with specified minimum coverage limits. The contract will be funded through capitated payments based on a per eligible per month (PEPM) methodology, with potential incentive payments tied to performance metrics. While specific total contract value is not explicitly stated, the CCBHC Demonstration funding projections range from $328.6 million in State Fiscal Year 2023 to $654.6 million in State Fiscal Year 2025, indicating a significant potential contract value. The selected contractor will be responsible for developing robust provider networks, implementing care coordination programs, and meeting extensive reporting requirements, including quarterly Network Adequacy Profile submissions and annual Network Access Plan reports. The contract includes a risk corridor mechanism where the contractor will bear 20% of gains or losses between 2% and 7% deviation from the target Medical Loss Ratio, and the state reserves the right to award the contract based on best value considerations.