Rural Hlth Transformation Primary Acct Care Transform Reimburse Design
Closed State & local contract opportunity Posted
- Solicitation number
- 26RFP-26-08RHT-008
- State
- South Dakota
- Responses due
Opportunity facts
- Jurisdiction
- NIGP code
Opportunity details come from postingboard.esmsolutions.com. Updated .
About this opportunity
The South Dakota Department of Social Services, Division of Medical Services is issuing a Request for Proposal to procure consulting services for developing an alternative payment methodology for Medicaid primary care services under the Rural Health Transformation initiative, specifically the Medicaid Primary Accountable Care Transformation (PACT) program. The vendor must provide comprehensive consulting services including population-based primary care methodology modeling, calculation of population-based and case management payment amounts, development of quality-based payment methodologies using HEDIS or comparable quality measures, design of recipient rewards programs, creation of methodologies for regular payment updates, and facilitation of stakeholder engagement meetings. Key deliverables include final rate modeling and recommendations due by January 1, 2027, with a target implementation date of January 1, 2028, and work must accommodate approximately 100,000 Medicaid recipients monthly with an estimated $80 million in annual eligible expenditures. The State prefers vendors utilizing actuaries for population-based payment calculations and requires detailed cost proposals with hourly rates for subject matter expert services, conference calls, and travel expenses evaluated independently from technical proposals. Critical deadlines include a Letter of Intent and offeror questions due by March 13, 2026, SFTP folder requests due by April 2, 2026, and proposals due by April 3, 2026 at 5:00 PM CT, with an anticipated award decision by April 30, 2026. The initial contract period will run from June 1, 2026 through May 31, 2029, with an option for two additional one-year renewals at the State's discretion.
The contract is 100 percent funded by the Centers for Medicare & Medicaid Services through a Rural Health Transformation Program financial assistance award, indicating no set-aside designations are mentioned in the documentation. Contractors must maintain Commercial General Liability insurance of at least $1,000,000 per occurrence, Professional Liability Insurance of at least $1,000,000, Business Automobile Liability of at least $1,000,000 per accident, and Workers' Compensation Insurance as required by South Dakota law. All work products, reports, plans, specifications, technical data, software, and documentation created under the contract become the exclusive property of the State and cannot be copyrighted without written approval. The contract is governed by South Dakota law with venue in the Sixth Judicial Circuit, Hughes County, South Dakota, and either party may terminate upon thirty days' written notice, or the State may terminate immediately upon breach. No incumbent vendors, existing infrastructure requirements, or specific award values are identified in the documentation, though the budget correlates to the $80 million in annual eligible Medicaid expenditures for primary care services.
Opportunity text
1.1 PURPOSE OF REQUEST FOR PROPOSAL (RFP) The Rural Health Transformation initiative is a statewide effort focused on strengthening rural healthcare systems and improving access to quality care across South Dakota. Through strategic investments, innovative care models, and cross-agency collaboration, Rural Health Transformation is designed to build a more resilient, connected, and sustainable rural health system for communities across the state.
The South Dakota Department of Social Services, Division of Medical Services (Medicaid) is seeking a vendor to assist the State with developing a population-based alternative payment methodology for South Dakota Medicaid primary care services including: Modeling a population-based primary care methodology; Calculating the population-based payment amounts; Calculating case management payment amount; Developing a methodology for regular updates to the payment methodologies; Developing a quality-based payment methodology based on provider performance on HEDIS or other quality measures; Developing a recipient rewards program for meeting established goals; Facilitating stakeholder engagement meetings;
The State is referring to this initiative as the Medicaid Primary Accountable Care Transformation (PACT). It is envisioned that PACT will provide flexible, population-based payments to primary care practices and incentivize both providers and patients to achieve quality outcomes while promoting shared accountability for cost and utilization. The target implementation date for the methodology is January 1, 2028.
The population-based payments will primarily be limited to evaluation and management services provided in non-institutional settings. It is anticipated PACT will also have a fee-for-service track for providers who do not wish to receive a population-based payment. In addition, it is anticipated that the payment design will be flexible to include providers currently paid at an encounter rate such as Federally Qualified Health Centers, Rural Health Clinics, Indian Health Service Clinics, and Tribal 638 clinics.
The State estimates the model will include approximately 100,000 Medicaid recipients on a monthly basis. The State estimates that approximately $80 million in annual Medicaid expenditures may be eligible for inclusion in the population-based payments.
Implementation of the PACT model is being funded with Rural Health Transformation Program (RHTP) funding. For more information about the PACT model, please see the State's RHTP project narrative https://doh.sd.gov/media/lyfbrd2k/sd_rhtproject-narrative-final.pdf.
Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after the date and time indicated in the Schedule of Activities. Inquiries must be emailed to Kirsten Blachford at Kirsten.Blachford@state.sd.us with the subject line "RFP26-08RHT-008".
The State will respond to offeror's inquiries (if required) via e-mail. In addition, all inquiries and the State's response will be posted on the state's e-procurement system and the DSS website at http://dss.sd.gov/keyresources/rfp.aspx. Offerors may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP. Offerors will be notified in the same manner as indicated above regarding any modifications to this RFP.
Files
| File | Type | Posted |
|---|---|---|
| RFP Document.pdf | ||
| Response to Offeror Questions document.pdf | ||
| RFP Document.pdf |
On GovTribe
Work this opportunity
- Track it in your pipeline
- Similar opportunities
- Ask GovTribe AI about this opportunity