Specialty Managed Care Plan

Nevada RFP 41NHA-S3708 is a formal request for proposals issued by the Nevada Health Authority's Division of Nevada Medicaid on behalf of Clark County and Fish Springs CDP to procure a specialty managed care organization to provide risk-based capitated managed care services for children and young adults with complex behavioral health needs and those involved with the child welfare system under Medicaid and Nevada Check Up (CHIP) programs. The procurement solicitation was released on February 12, 2026, with a submission deadline of May 1, 2026, at 2:00 P.M. Pacific Time through the nevadaepro.com platform, with vendor questions due by specified Q&A deadlines and vendor presentations potentially scheduled for June 12, 2026. The contractor will operate the specialty managed care plan from July 1, 2027, through December 31, 2030 (three and one-half years), with a potential two-year extension, and must serve initial mandatory service areas in urban Washoe and Clark counties beginning July 1, 2027, expanding statewide by January 1, 2030. Key deliverables and service requirements include comprehensive covered services for behavioral health, care coordination, pharmacy, emergency services, EPSDT, and home and community-based services; establishment of a network meeting stringent time and distance standards; implementation of robust care management including wraparound facilitation and intensive care coordination services; maintenance of a minimum Medical Loss Ratio of 85 percent; contribution of at least 2 percent of annual profit to community reinvestment initiatives; compliance with mental health parity requirements; maintenance of a performance security deposit of 110 percent of the highest month's capitation or $5 million (whichever is greater); extensive reporting and documentation to the Nevada Health Authority and Department of Justice Settlement Monitor; and achievement of NCQA accreditation within one year of the go-live date. Vendor qualifications include mandatory compliance with 42 CFR 438.2 (Managed Care Organization definition) and NRS 695G, possession of or ability to obtain a Certificate of Authority from the Nevada Division of Insurance, NCQA accreditation, and good faith bid submission per NRS 695K.220(2). The evaluation criteria consist primarily of a pass/fail assessment for most components, with technical proposal questions scored across five weighted topic areas: Overall Experience (200 points, 20 percent), Care Management (250 points, 25 percent), Provider Network (250 points, 25 percent), Service Delivery (100 points, 10 percent), and Complex Case Scenarios (200 points, 20 percent), with bonus points available, totaling 1,000 points maximum.

The RFP does not identify specific set-asides for disadvantaged enterprises, minority-owned businesses, or other restricted categories, though all contractors and subcontractors must comply with comprehensive federal civil rights laws and Nevada Revised Statutes governing non-discrimination and equal opportunity. No incumbent vendor or current contractor is identified in the solicitation materials, indicating this represents a new contract opportunity. Prospective bidders must comply with extensive federal and state regulatory requirements including HIPAA and HITECH Act provisions for protected health information handling, maintain mandatory insurance coverage including Commercial General Liability ($2,000,000 general aggregate, $1,000,000 per occurrence), Automobile Liability ($1,000,000 combined single limit), Workers' Compensation (statutory rates with $100,000/$500,000 Employers' Liability limits), and Professional Liability/Errors and Omissions ($1,000,000 per claim, $2,000,000 annual aggregate). All costs associated with providing covered Medicaid and Nevada Check Up services—including medical, behavioral health, pharmaceutical, and transportation benefits—are to be included in fixed, actuarially sound capitation rates that will be finalized in a contract amendment through collaboration between State and bidder actuaries; however, specific budget values or award ranges are not disclosed in the solicitation documents. The State reserves the right to reject any or all responses, limit scope of work, modify solicitation provisions, and make awards based on best value rather than lowest price, with contract awards contingent upon successful negotiations and Board of Examiners approval.