Rate Setting C5987

The Commonwealth of Kentucky, Cabinet for Health and Family Services (CHFS), Department for Medicaid Services is soliciting proposals through RFP 746 2600000131 for comprehensive Medicaid rate-setting services on a personal service contract basis. The selected vendor will provide analytical services for establishing Medicaid reimbursement rates across multiple provider types, including nursing facilities, hospitals, psychiatric facilities, federally qualified health centers, and clinics. Primary deliverables and objectives include performing cost report reviews, conducting approximately 80 field audits annually, providing appeals support, managing MDS (Minimum Data Set) data, developing rate models, coordinating training, and assisting with grant activities. The vendor must establish and maintain a full-time office in Frankfort, Kentucky, with a minimum staff of four personnel, including a CPA project manager with specified Medicaid experience, a project staff CPA, and personnel with facility reimbursement and MDS/RUG knowledge. Required qualifications also include maintaining professional liability insurance of $1,000,000 per claim and commercial general liability insurance of $1,000,000 per occurrence/$2,000,000 aggregate. The initial contract term runs from July 1, 2026, through June 30, 2028, with renewal options for up to two additional two-year periods subject to Secretary of Finance and Administration Cabinet approval and Legislative Research Commission review. Proposals will be evaluated on technical merit (maximum 1,000 points), cost (maximum 300 points), and oral presentations if required (maximum 200 points), for a total of 1,500 possible points, with proposals scoring below 600 points on technical evaluation being eliminated from consideration. Written questions must be submitted by April 13, 2026, with proposals due by May 6, 2026, at 2:00 PM Eastern Time.

The RFP documentation does not indicate any specific set-aside designations or restrictions limiting responses to disadvantaged enterprises or particular organizational types. No incumbent vendors or current contractors are identified in the available solicitation materials. The cost proposal form requires vendors to submit hourly rates for each service category, with estimated hours allocated across five primary service areas: Project Work Plan, Long Term Care Rate Setting, Hospitals and Facilities Setting, Primary Care Centers/FQHCs/ICF/IID/DD/CMHC/RHC Setting, and Kentucky Resident Assessment Training, plus Ad Hoc services estimated at 800 hours billed at an hourly rate. Monthly invoicing will be submitted based on billable hours, with no expense reimbursement authorized unless specifically approved in the contract. The solicitation does not guarantee any minimum use of services, and CHFS reserves the right to establish or award other contracts for related work. Vendors selected for this contract must execute a Business Associate Agreement compliant with HIPAA regulations to protect protected health information, including implementing required administrative, physical, and technical safeguards and maintaining breach notification protocols.