T2302 - School-Based Health Services (SBHS) and Medicaid Administrative Claiming (MAC) Program

The State of New Jersey Department of the Treasury is seeking a contractor to manage the School-Based Health Services (SBHS) and Medicaid Administrative Claiming (MAC) Program, a seven-year procurement designed to support administrative claiming activities for school-based health services across New Jersey's public school districts. The primary objectives include maximizing federal Medicaid reimbursement for services provided to special and general education students, collecting and analyzing student service data, and maintaining critical system applications. Key deliverables include developing and implementing electronic systems for tracking Medicaid-eligible student services, conducting quarterly Random Moment Time Studies (RMTS), processing claims for reimbursement, and providing comprehensive technical assistance and training to local education agencies. The bid solicitation (Bid #26DPP01194) requires vendors to submit detailed technical approaches, demonstrate staffing qualifications, and provide firm-fixed pricing across three service categories: system development/testing/implementation, annual maintenance and operations, and help desk services. An optional pre-quote conference is scheduled for November 5, 2025, with electronic questions due by November 25, 2025, and quote submissions due by January 21, 2026, at 2:00 PM. Evaluation will be based on technical approach, staff qualifications, firm experience, help desk capabilities, and pricing, with the potential for negotiation or best and final offer requests.

The procurement is designated as a Small Business Subcontracting Set-Aside contract, requiring bidders to demonstrate good faith efforts to solicit and utilize New Jersey Small Business Enterprises, including small, woman-owned, minority-owned, veteran-owned, and disabled veteran-owned businesses. Vendors must maintain Professional Liability Insurance of at least $1,000,000 per occurrence and Cyber Breach Insurance of at least $2,000,000 per occurrence, with the contractor's liability limited to 200 percent of fees paid in the previous twelve months or $1,000,000, whichever is greater. The state anticipates approximately 400 participating public school districts with multiple users logging claims, and the selected system must support this volume without interruption. While no specific incumbent vendor is mentioned, the state has been working with Public Consulting Group (PCG) as a third-party administrator for existing programs. The contract includes a base seven-year term with the possibility of three additional one-year extensions, and while specific budget ranges are not explicitly stated, the State Plan Amendment indicates federal budget impacts of $54,238,396 for Fiscal Year 2024 and $110,902,915 for Fiscal Year 2025, suggesting a significant potential contract value.