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Actuarial Services


Location
Nevada
Publication Date
06/03/2019 12:54 PM EDT
Closing Date
07/25/2019 05:00 PM EDT
Issuing Organization
State of Nevada - Department of Health and Human Services
Solicitation Number
Description

Specifications include, but are not limited to: The selected vendor will support the Title XIX Nevada Medicaid Program and the Title XXI CHIP Program, known in Nevada as Nevada Check Up, by developing an actuarially sound methodology for capitated rates to be paid to Medicaid MCOs. The vendor will also verify the data received from providers is accurate, complete, and timely, review and analyze annual financial statements and prepare reports estimating the financial impact and cost benefit of the managed care service delivery models. In addition, the vendor will participate with state representatives in communication and planning activities and provide consulting services, including the provision of strategic planning services to DHCFP administrators and managers. The vendor shall provide technical assistance on additional projects as requested. 2.1.1.1 Methodology. Develop, document, and support actuarially sound rate setting methodologies for capitated rates for all Nevada Medicaid and Nevada Check Up populations. Vendor may also be required to develop capitated rates for other Medicaid populations and services such as the aged, blind, and disabled and non-emergency transportation services. In all cases where rates are developed for an enrollee population, DHCFP requires that fully benchmarked rates be produced for each year of the contract term; rates produced in the interim of a year in which benchmarked rates were produced may utilize actuarially sound trends and indices. A. Provide training and technical assistance concerning rate setting methodology to DHCFP personnel as needed. This includes training agenda and materials for specific sessions, delivery of training related to use of rate setting methodologies, and statistical data analysis. 2.1.1.2 Calculations. Develop and support actuarially sound rate structures to be applied to the following: A. Medicaid and Nevada Check Up MCO populations of approximately 456,217 participants currently, subject to change. 2.1.1.3 Follow up with the MCOs regarding Capitation Rates as requested, outstanding questions regarding Capitation Rate development or payment methods, rate cell questions, and other items. This will include leading discussions between the Vendor, the DHCFP, and the MCOs to address MCO concerns regarding emerging experience and capitation rates and supporting the DHCFP in negotiations and finalizing contracts with MCOs.

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