Third Party Administrator Rebid

The Arkansas Department of Transformation and Shared Services is seeking a Third Party Administrator (TPA) to manage comprehensive health insurance and medical management services for state and public school employees. The procurement involves administering benefits for approximately 160,000 total lives, including 70,716 individual employees across state and public school systems, with a seven-year contract potential (initial three-year term with four potential one-year renewals). The selected TPA will be responsible for health insurance administration, medical management programs, and optional employee assistance program services, with key objectives including cost savings, competitive financial features, robust provider networks, and comprehensive medical management capabilities. Specific service requirements include case management, disease management, utilization management, maternity management, and wellness programs. The proposal is due on April 21, 2025, at 10:00 AM Central Time, with an anticipated contract award in June 2025 and a planned implementation date of January 1, 2026. Evaluation criteria will be weighted 60% for technical proposal and 40% for cost, with a maximum possible score of 1,000 points. Proposing contractors must demonstrate at least five years of large group health insurance experience, be SOC-2 Level II and SSAE-18 compliant, and hold URAC or NCQA accreditation.

The solicitation does not explicitly outline specific set-aside designations or restrictions for disadvantaged enterprises. The current provider appears to be Arkansas Blue Cross Blue Shield, as evidenced by the attached utilization reports. The contract will require integration with existing employee assistance programs provided by Lucet, which currently serves the state with comprehensive support services. Technology integration will necessitate robust data management capabilities, including compliance with HIPAA and HITECH Act regulations, as outlined in the Business Associate Agreement. While specific budget ranges are not directly stated, the pricing structure is based on per member per month (PMPM) fees across multiple service categories, with the official solicitation price sheet indicating a complex pricing methodology that includes administrative services, claims administration, network management, and medical management services. The estimated member population of approximately 144,000-160,000 suggests a substantial contract value, with potential for significant financial investment over the seven-year contract period.